This toolkit is one of a suite of three focused on trauma. The full suite includes: Trauma and suicide, Trauma and suicide in children and Trauma and suicide in Indigenous people. Introduction Trauma is very common among people in Canada. Most people receiving treatment for mental health issues have had some form of trauma (Rosenberg, 2011). Trauma places us at a higher risk for mental health issues such as depression and addiction. People who have experienced trauma are also at a greater risk for suicide. What is Trauma? Trauma is “a horrific event beyond the scope of normal human experience” (Greenwald, 2007, p.7). Some examples of traumatic experiences include: motor vehicle collision; rape; losing a loved one; and childhood abuse or neglect. Some effects of trauma are: alcoholism; depression; insomnia; suicide attempts; and relationship problems. (Centre for Addictions and Mental Health, 2012) Symptoms of trauma include: disconnection from self; emotional numbing (including drinking alcohol and doing drugs); eeduced awareness or hyper-awareness of surroundings; memories, flashbacks, and/or nightmares of the traumatic event; blame of self or others; loss of interest in former activities; aggressive or risk-taking behaviours; and/or change in sleeping habits. (American Psychiatric Association (APA), 2013) Disorders associated with trauma Acute Stress Disorder (ASD) may be an individual’s initial reaction to a traumatic event. If trauma symptoms (noted above) go on for more than one month, that individual should be assessed for Post Traumatic Stress Disorder (PTSD). Symptoms of ASD and PTSD may trigger other disorders such as substance use, anxiety, mood, personality, and eating disorders (Halpern, Maunder, Schwartz & Gurevich, 2011; APA, 2013). When a traumatized individual has one or more disorder they are at higher risk for suicide. Who is at risk? Everyone is at risk of trauma, especially: people with poor/deteriorating health; people receiving ongoing medical treatment (e.g. cancer and psychiatric patients); homeless people; Indigenous people; children who have suffered neglect; refugees; first responders (e.g. police, fire fighters, paramedics); military personnel and veterans; and medical doctors. What is Trauma-Informed Care? Health care professionals are more aware of the effects of trauma than ever, and this has led to the creation of Trauma-Informed Care (TIC) -- a determined effort to implement a better approach to treating patients that takes into account the impact that previous traumatic experiences have had on an individual’s overall mental health. TIC represents a significant paradigm shift from what has been called a “deficit perspective” to one that is strengths-based (British Columbia Ministry of Health, 2013). “What is wrong with you?” has shifted to “What has happened to you?” (Rosenberg, 2011). Trauma-Informed Care (TIC) can be adopted by anywhere in the “behavioural health system” including: emergency rooms; doctors’ offices; rehabilitation centres; transitional housing centres; and counselling offices. Being trauma-informed means: understanding the prevalence of trauma and its impact; recognizing the signs and symptoms of traumatization; creating an emotionally and physically safe space, and empowering the individual with an active voice in collaborative decision-making; and respecting the person’s experience through active listening, being sensitive to the language used, being transparent, being trustworthy, and offering stability and consistency. (Bath, 2008; Hodas, 2006; Rosenberg, 2011; SAMHSA, 2015; Huckshorn & LeBel, 2013). Read more about TIC in iE13: Trauma Informed Care: Trauma, Substance abuse and Suicide Prevention Trauma-Informed Interventions and Therapies Psychological First Aid Psychological First Aid is an evidence-informed approach for assisting children, adolescents, adults, and families in the aftermath of disaster and terrorism. Critical Incident Stress Debriefing (CISD) is a “7-phase, small group supportive crisis intervention process” (Mitchell, n.d., p.1). Cognitive Behavioural Therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. Exposure Therapy is an approach that allows the patient to confront their traumatic memories either all at once or gradually. Eye Movement Desensitization Reprocessing (EMDR) is an evidence-based psychotherapy for PTSD which aims to reorient and repair the patient’s inability to process traumatic experiences. Narrative Therapy is a psychotherapeutic approach which allows people to re-tell and re-interpret their personal stories and gives them an opportunity to construct alternative possibilities to their individual narratives. Stress Inoculation Training (SIT) is a psychotherapy method intended to help patients prepare themselves in advance to handle stressful events successfully and with a minimum of upset (SAMHSA, 2014). References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, DSM-5 (5th ed.). Washington, DC: American Psychiatric Publishing. Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children and Youth, 17(3),17-21. British Columbia Ministry of Health. (2013). Trauma-Informed Practice Guide. Retrieved from http://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf Centre for Addictions and Mental Health. (2012). Trauma: What is trauma? Retrieved from http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/Trama/Pages/default.aspx Elliott, D., Bjelajac, P., Fallot, R., Markoff, L., & Reed, B. (2005). Trauma-informed or trauma-denied: Principles and implementation of trauma-informed services for women. Journal of Community Psychology, 33(4), 461-477. Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. New York: Routledge. Halpern, J., Maunder, R., Schwartz, B., & Gurevich, M. (2011). Identifying risk of emotional sequelae after critical incidents. Emergency Medicine Journal. Retrieved from http://emj.bmj.com/content/early/2010/05/29/emj.2009.082982.short Hodas, G. (2006). Responding to childhood trauma: The promise and practice of trauma informed care. Retrieved from http://www.childrescuebill.org/VictimsOfAbuse/RespondingHodas.pdf Huckshorn, K. & LeBel, J. (2013). Trauma-informed care. In Yeager, K., Cutler, D., Svendsen, D., & Sills, G. (Eds.), Modern community mental health: An interdisciplinary approach (p.62-83). Oxford, UK: Oxford University Press. Klinic Community Health. (2013). Trauma-informed: The trauma toolkit. Retrieved from http://www.klinic.mb.ca/docs/PostersAndBrochures/Klinic%20Trauma%20-%20a%20normal%20reaction%20Broch.pdf Mitchell, J. (n.d.). Critical Incident Stress Debriefing. Retrieved from http://www.info-trauma.org/flash/media-e/mitchellCriticalIncidentStressDebriefing.pdf Olson, R. (2013). infoExchange 13: Trauma informed care. Retrieved from https://suicideinfo.ca/LinkClick.aspx?fileticket=6UAobvbsp7Y%3d&tabid=625 Rosenberg, L. (2011). Addressing trauma in mental health and substance use treatment. The Journal of Behavioral Health Services & Research, 38(4), 428-431. Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Trauma-informed care in behavioral health services: A treatment improvement protocol. Rockville, MD: U.S. Department of Health and Human Services.
This toolkit is one of a suite of three focused on trauma. The full suite includes: Trauma and suicide, Trauma and suicide in children and Trauma and suicide in Indigenous people. Introduction When children and adolescents experience trauma, their personal development can be affected. They may develop mental health issues and have a higher risk for suicide (Felitti, et al., 1998; Gaskill & Perry, 2012; Hodas, 2006; Levers, 2012; Shaw, 2000). Unresolved trauma in childhood and adolescence is linked to an increased risk of suicide ideation and if unaddressed, can escalate with age -- potentially leading to suicide attempts or death by suicide. Early intervention post-trauma is crucial (Dube et al., 2001; Herba, Ferdinand, van der Ende & Verhulst, 2007; Pfeffer, Normandin & Kakuma, 1998). What is Trauma? Trauma is “a horrific event beyond the scope of normal human experience” (Greenwald, 2007). Some examples of traumatic experiences for children and adolescents include: neglect; violence in their community, home, or school; sexual or physical abuse; motor vehicle collisions; medical trauma (eg. surgery); refugee and war zone trauma; terrorism; and natural disasters. (American Psychological Association (APA), 2008; Spinazzola, et al., 2014; The National Child Traumatic Stress Network (NCTSN), n.d.a) Some immediate and future effects of trauma are: poor academic performance; insomnia; relationship problems; depression; alcoholism or illicit drug use; and/or suicide attempts. (Centre for Addictions and Mental Health, 2012; Centers for Disease Control and Prevention, n.d.) Coping with Trauma Children can better cope with trauma if they: have positive relationships with family and friends; have built up resiliency; have access to health care and social services; and live in communities that support parents and undertake initiatives to prevent abuse. (Centers for Disease Control and Prevention, 2015; Hodas, 2006) Warning signs and Symptoms of Trauma Children and adolescents who have been traumatized may: Develop new fears and anxiety, e.g. fear future trauma; Feel helpless, numb, alone, and/or depressed; Exhibit changes in behaviour, e.g. decrease in appetite; Experience sleep difficulties, e.g. recurrent nightmares, insomnia; Have feelings of guilt and shame surrounding the traumatic event; Complain of physical ailments, e.g. upset stomach; Continually tell others about the event; Fear separation from parents/caregivers (young children); Exhibit dysregulated behaviour, e.g. crying, irritability, aggression (young children); Exhibit regression, e.g. bedwetting, baby talk (young children); Ask about death (young children); Re-enact traumatic event through play (children); Become more attached and reliant on caregivers (children); Experience suicidal ideation (teens); Engage in risky behaviours, e.g. drug/alcohol abuse and sexual promiscuity (teens); and/or Start self-harming behaviours, e.g. cutting, eating disorders (teens). (APA, 2008; Hodas, 2006; Shaw, 2000; NCTSN, n.d.b) What is Trauma-Informed Care? Health care professionals are more aware of the effects of trauma than ever, and this has led to the creation of Trauma-Informed Care (TIC) -- a determined effort to implement a better approach to treating patients that takes into account the impact that previous traumatic experiences have had on an individual’s overall mental health. TIC represents a significant paradigm shift from what has been called a “deficit perspective” to one that is strengths-based (British Columbia Ministry of Health, 2013). The new essential question reflects this shift, having changed from: “What is wrong with you?” to “What has happened to you?” (Rosenberg, 2011) Trauma-Informed Care (TIC) can be adopted by anyone working in the “behavioural health system” including: emergency rooms; doctors’ offices; and counselling offices. Being trauma-informed means: understanding the prevalence of trauma and its impact; recognizing the signs and symptoms of traumatization; creating an emotionally and physically safe space, and empowering the individual with an active voice in collaborative decision-making; and respecting the person’s experience through active listening, being sensitive to the language used, being transparent, being trustworthy, and offering stability and consistency (Bath, 2008; Hodas, 2006; Rosenberg, 2011; SAMHSA, 2015; Huckshorn & LeBel, 2013). Read more about TIC in iE13: Trauma Informed Care: Trauma, Substance abuse and Suicide Prevention Trauma-Informed Interventions and Therapies Trauma-Focused Cognitive Behavioural Therapy (TF CBT) An approach that uses a combination of Cognitive Behavioural Therapy (CBT) and trauma-informed practice for working with children who have experienced traumatic events and their parents (Levers, 2012). Child-Parent Psychotherapy (CPP) This treatment is used to restore and protect the child’s mental well-being by supporting and improving the child-caregiver relationship (Levers, 2012). Parent-Child Interaction Therapy (PCIT) PCIT is a two-phase approach, 1. Child-Directed Interaction (CDI) and 2. Parent-Directed Interaction (PDI), with a focus on positive behaviours and techniques for behavioural management (Levers, 2012). Play Therapy Play therapy gives children the opportunity to reenact their trauma allowing them to process the experience (Levers, 2012). Eye Movement Desensitization and Reprocessing for Children and Adolescents (EMDR) Clients process and describe the emotionally difficult memories associated with their traumatic experiences, while keeping their focus on an external stimulus (The California Evidence-Based Clearinghouse for Child Welfare (CEBC), 2014; Levers, 2012). Prolonged Exposure Therapy for Adolescents (PE-A) PE-A has a main goal of helping clients achieve the ability to emotionally process their traumatic experiences through in vivo exposure, imaginal exposure, education about reactions to trauma and breathing techniques (CEBC, 2014; Levers, 2012). Resources Center on the Developing Child: Harvard University Child Trauma Academy The National Child Traumatic Stress Network (NCTSN) Substance Abuse and Mental Health Services Administration (SAMHSA) 211 (Available in British Columbia, Alberta, Saskatchewan, Ontario, Quebec, New-Brunswick, Nova Scotia and Nunavut) Kids’ Help Phone 1-800-668-6868 National Domestic Violence Hotline 1-800-799-7233 or 1-800-787-3224 (TDD) References American Psychological Association. (2008). Children and trauma: Update for mental health professionals. Washington, DC: American Psychological Association. Retrieved from http://www.apa.org/pi/families/resources/children-trauma-update.aspx Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children and Youth, 17(3), 17-21. California Evidence-Based Clearinghouse for Child Welfare. (2014). List of programs. Retrieved from http://www.cebc4cw.org/search/by-program-name/ Centre for Addictions and Mental Health. (2012). Trauma: What is trauma? Retrieved from http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/Trama/Pages/default.aspx Centers for Disease Control and Prevention. (2015). Child maltreatment: Risk and protective factors. Retrieved from http://www.cdc.gov/ViolencePrevention/childmaltreatment/riskprotectivefactors.html Dube, S., Anda, R., Felitti, V., Chapman, D., Williamson, D., & Giles, W. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the adverse childhood experiences study. Journal of the American Medical Association, 286(24), 3089-3096. Felitti, V. & Anda, R. (2003). Origins and essence of the study. ACE Reporter, 1(1). Retrieved from http://www.acestudy.org/yahoo_site_admin/assets/docs/ARV1N1.127150541.pdf Fergusson, D., Horwood, J., & Lynskey, M. (1996). Childhood sexual abuse and psychiatric disorder in young adulthood, II: Psychiatric outcomes of childhood sexual abuse. Journal of the American Academy of Child & Adolescent Psychiatry, 35, 1365–1374. Fremont, W.(2004). Childhood reactions to terrorism-induced trauma: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry 43(4), 381–392. doi:10.1097/00004583-200404000-00004 Gaskill, R. & Perry, B. (2012). Child sexual abuse, traumatic experiences and their effect on the developing brain. In P. Goodyear-Brown (Ed.), Handbook of child sexual abuse: Identification, assessment and treatment (pp. 29-49). New York, NY: John Wiley & Sons, Inc. Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. New York: Routledge. Herba, C., Ferdinand, R., van der Ende, J., & Verhulst, F. (2007). Long-term associations of childhood suicide ideation. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1473-1481. Hodas, G. (2006). Responding to childhood trauma: The promise and practice of trauma informed care. Retrieved from http://www.childrescuebill.org/VictimsOfAbuse/RespondingHodas.pdf Huckshorn, K. & LeBel, J. (2013). Trauma-informed care. In Yeager, K., Cutler, D., Svendsen, D., & Sills, G.(Eds.), Modern community approach mental health: An interdisciplinary approach (pp. 62-83). Oxford, UK: Oxford University Press. Levers, L. (2012). Trauma counseling: Theories and interventions. Springer Publishing Company. NY: New York. National Child Traumatic Stress Network. (n.d.a). Refugees and the refugee experience. Retrieved from http://nctsn.org/trauma-types/refugee-trauma/learn-about-refugee-experience National Child Traumatic Stress Network. (n.d.b). Resources for parents and caregivers. Retrieved from http://www.nctsn.org/resources/audiences/parents-caregivers Pfeffer, C., Normandin, L., & Kakuma, T. (1998). Suicidal children grow up: Relations between family psychopathology and adolescents’ lifetime suicidal behavior. Journal of Nervous and Mental Disease, 186(5), 269-275. Public Health Agency of Canada. (2008). Canadian incidence study of reported child abuse and neglect: Major findings. Retrieved from http://cwrp.ca/sites/default/files/publications/en/CIS-2008-rprt-eng.pdf Rosenberg, L. (2011). Addressing trauma in mental health and substance use treatment. The Journal of Behavioral Health Services & Research, 38(4), 428-431. Salzinger, S., Rosario, M., Feldman, R., & Ng-Mak, D. (2007). Adolescent suicidal behavior: Associations with preadolescent physical abuse and selected risk and protective factors. Journal of the American Academy of Child & Adolescent Psychiatry, 46(7), 859-866. Shaw, J. (2000). Children, adolescents and trauma. Psychiatric Quarterly, 71(3), 227- 243. Spinazzola, J., Hodgdon, H., Liang, L., Ford, J., Layne, C., Pynoos, R., Briggs, E., Stolbach, B., & Kisiel, C. (2014). Unseen wounds: The contribution of psychological maltreatment to child and adolescent mental health and risk outcomes. Psychological Trauma: Theory, Research, Practice, and Policy, 6(1), s18-s28. DOI: 10.1037/a0037766 Substance Abuse and Mental Health Services Administration. (2015). Trauma-informed approach and trauma-specific interventions. Retrieved from http://www.samhsa.gov/nctic/trauma-interventions
Many people have been impacted by suicide or at least know someone who has. It is not someone else’s problem. It is our problem. Fortunately, suicide is preventable. Most people who die by suicide do not necessarily want to die. They simply want the pain of living to stop. We can help. One of the mandates that we have at the Centre for Suicide Prevention is to inform and educate the public about the facts of suicide. One way we educate is by training people how to identify and intervene with someone at risk of suicide. We are making a real difference on both counts. This toolkit is a collection of basic statistics, facts, myths and suicide prevention resources. Statistics The World Every year, almost one million people die from suicide. There is a “global” mortality rate of 16 per 100,000. In the last 45 years suicide rates have increased by 60% worldwide. United States In 2010, 38,364 suicides were reported, making suicide the 10th leading cause of death for Americans. Canada In 2015 there were 4,405 deaths by suicide in Canada. 3,269 were male and 1,136 were female. Men aged 40-59 had the highest number of suicides In Canada with 1,348, followed by males aged 20-39 with 945 (Statistics Canada, 2018). Suicide accounts for 24% of all deaths among 15-24 year olds. Alberta In 2016, in Alberta, there were 539 suicide deaths. In 2010, there were 1,833 attempted suicide/self-inflicted injury-related hospital admissions. There were 5,053 attempted suicide/self-inflicted injury-related emergency department visits. Females accounted for 58% of the hospital admissions and 61% of the emergency department visits for attempted suicide/self-inflicted injuries. Economics of Suicide How much in economic terms do suicides cost our nation and other countries? Mental health issues cost Canada upwards of 51 billion dollars a year, and these figures may not even account for less calculable illnesses such as depression and anxiety. A study in New Brunswick in 1996 found the cost of suicide per death to be $849,877.80 (Clayton, 93). In 2000, the cost of total suicides in the U.S. was estimated to be $12.4 billion in lost wages and productivity for approximately 30, 000 suicides (CDC, 46). In 2002 in New Zealand, the cost of 460 nation-wide suicides was $206,192,000 and the cost for 5095 attempted suicides was $238,531,000 (O’Dea, ix). Myths and Facts Myth Suicide notes are always left at time of suicide. Fact Notes are rarely left by someone who dies by suicide. According to Antoon Lenaars, the percentage of those who leave notes varies from 12% to 15% (1988). Thomas Joiner mentions a figure of 25% (2010). It is a troubling myth because many believe a note must be present to deem a death a suicide. This can be especially important to those bereaved by a suicide. If a death is not accepted as a suicide, the grieving process can only become more difficult and closure may become more elusive. Myth People who talk about suicide should not be taken seriously. Fact The American Association of Suicidology (AAS) has suicidal talk as a major warning signs for suicidal risk. This myth suggests that those who talk about suicide are just trying to get attention. Suicidal behaviour should always be taken seriously. Suicidal talk often begins with suicidal thoughts which can escalate to suicidal acts such as attempted suicide if the appropriate interventions are not made. Suicidal behaviour should always be taken seriously. Myth Children do not die by suicide. Fact It is widely believed that children are incapable of dying by suicide because they lack the mental development necessary to carry out such an act. Although cases of suicide of children 10 and under are rare, it is known to be under-reported. Some deaths of children are documented as accidental but many are actual suicides. Children can and do die by suicide. Myth Talking about suicide can cause suicide. Fact On the contrary, talking about suicide with someone who may be suicidal reduces the risk that they may attempt. They should be asked directly if they are having suicidal thoughts or have a plan in place. It has been shown that when someone at risk is given the opportunity to talk, their threat to carry through with suicide diminishes (Suicide Resource Group,1999). Myth Once someone has attempted suicide, they will not attempt again. Fact People who have attempted in the past are the most at-risk for future attempts. The chief predictor of a future suicide is a past attempt. The rate of suicide is 40 times higher for those who have attempted already. It is particularly a harmful myth when studied in a health care setting. Some reports suggest that health care workers view attempters as attention seekers instead of people at risk of dying. An emphasis needs to be placed on getting those who have attempted suicide to get the (mental) health attention they require (SPA, 2009). Myth The suicide rate is highest around Christmas. Fact This is not true. In fact, though the rate is fairly constant throughout the year, it rises slightly after the holidays in January and peaks in early spring. Some think the holiday season can be a protective factor for those at risk (CSP, 2013). Joiner calls it a “time of togetherness”(2010) and can definitely lessen the chances of a suicide as someone feels more connected or more obliged to make it through the holiday season in the interest of harmony. Warning Signs AAS has developed a mnemonic to remember suicidal warning signs: IS PATH WARM? I – Ideation S – Substance Abuse P – Purposelessness A – Anxiety T – Trapped H – Hopelessness W – Withdrawal A – Anger R – Recklessness M – Mood Changes Warning Signs of Acute Risk Include: Threatening or hurt to kill him or herself, or talking of wanting to hurt or kill him/herself; and/or Looking for ways to kill him/herself by seeking access to firearms, available pills, or other means; and/or Talking or writing about death, dying or suicide, when these actions are out of the ordinary (American Association of Suicidology) Workshops The Centre for Suicide Prevention offers several comprehensive workshops that will educate you on the topic of suicide. While all of our workshops are about suicide prevention, they all have specific purposes and goals. Straight Talk: Youth Suicide Prevention Workshop Straight Talk is a youth-focused workshop for people working with youth ages 12 to 18. Tattered Teddies: Preventing Suicide in Children This half-day workshop will examine warning signs in a child and intervention strategies. River of Life: Indigenous Youth Suicide Prevention The River of Life course discusses strategies designed to strengthen the protective factors of youth at risk. ASIST: Applied Suicide Intervention Skills Training Attending this two-day course will train you to intervene with an individual who is suicidal. safeTALK: suicide alertness for everyone This three hour workshop emphasizes the importance of recognizing the signs, communicating with the person at risk and getting help or resources for the person at risk. Related Links American Association of Suicidology (AAS) An education and resource organization. Canadian Association for Suicide Prevention (CASP) Provides information and resources to communities to reduce the suicide rate and minimize the harmful consequences of suicidal behaviour. Canadian Mental Health Association (CMHA) Promotes the mental health of all and supports the resilience and recovery of people experiencing mental illness through advocacy, education, research and service. International Association of Suicide Prevention (IASP) Dedicated to preventing suicidal behaviour, alleviating its effects, and providing a forum for academics, mental health professionals, crisis workers, volunteers and suicide survivors. Suicide Prevention Australia Provides policy advice to governments, community awareness and public education, increased involvement in research and a future role in leading Australia’s engagement internationally. Suicide Prevention Resource Center (SPRC), USA Provides technical assistance, training, and materials to increase the knowledge and expertise of suicide prevention practitioners and other professionals serving people at risk for suicide. References Alberta Centre for Injury Control and Research. (2012). Suicide/self-inflicted injuries in Alberta. Retrieved from http://acicr.ca/Upload/Newsletter-data-pages/Suicides%202010%20data.pdf American Association of Suicidology.(2013). Know the warning signs. Retrieved from http://www.suicidology.org/resources/warning-signs American Foundation for Suicide Prevention. Facts and figures: Suicide deaths. Retrieved from http://www.afsp.org/understanding-suicide/facts-and-figures Canadian Mental Health Association. (2012). Mental health is costly—but how costly? Retrieved from http://calgary.cmha.ca/public_policy/mental-illness-is-costly-%e2%80%93-but-how-costly/ Center for Disease Control. (2012). Suicide facts at a glance. Retrieved from http://www.who.int/mental_health/prevention/suicide/suicideprevent/en/index.html Centre for Suicide Prevention.(2013). Is it true that most suicides leave notes? Frequently Asked Questions. Retrieved from http://suicideinfo.ca/Library/AboutSuicide/FAQ.aspx Clayton, D. and Barcelo, A. (1999). The cost of suicide mortality in New Brunswick. Chronic Diseases in Canada, 20(2),89-95. King, K.(1999). Fifteen prevalent myths concerning adolescent suicide. Journal of School Health,69(4),159-161. Joiner, T. (2010). Myths about suicide. Cambridge, MA.:Harvard University Press. Leenars, A.(1988). Suicide notes: Predictive clues and patterns. New York: Human Sciences Press. Marcus, E.(2010). Why suicide: Questions and answers about suicide, suicide prevention and coping with the suicide of someone you know. New York: HarperOne. O’Dea, Des and Tucker, Sarah. (2005). The cost of suicide to society. Wellington: Ministry of Health Office of the Chief Medical Examiner, Alberta Justice. (2009). 2009 annual review. Retrieved from http://justice.alberta.ca/programs_services/fatality/ocme/Documents/2009-OCME-AnnualReview.pdf Schurtz, D., Cerel, J. and Rodgers, P.(2010).Myths and facts about suicide from individuals involved in suicide prevention. Suicide and Life-Threatening Behavior,40(4),346-352. Statistics Canada.(2018). Suicides and suicide rate, by sex and by age group (Both sexes no.). Retrieved from http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/hlth66c-eng.htm Suicide Prevention Australia. (2009). Position statement: Supporting suicide attempt survivors. Retrieved from http://suicidepreventionaust.org/wp-content/uploads/2012/01/SPASuicideAttemptSurvivors-PositionStatement.pdf Suicide Reference Group.(2006). The Myths of Suicide. Retrieved from http://www.wrspc.ca/ pdf/mythsofsuicide.pdf World Health Organization.(2013). Suicide Prevention. Retrieved from http://www.who.int/ mental_health/prevention/suicide/suicideprevent/en/
This toolkit is one of a suite of three focused on trauma. The full suite includes: Trauma and suicide, Trauma and suicide in children and Trauma and suicide in Indigenous people. Trauma is very common among people in Canada, and the Indigenous people in Canada (First Nations, Metis and the Inuit) have nearly 4 times the risk of severe trauma than the non-Indigenous population (Haskell & Randall, 2009). Colonialism is responsible for much of the trauma experienced by Indigenous people all over the world, and its effects continue to this day (Linklater, 2014; Haskell & Randell, 2009). Most people receiving treatment for mental health issues have had some form of trauma (Rosenberg, 2011). Trauma places people at higher risk for additional mental health issues such as depression and addiction. People who have experienced trauma are also at greater risk for suicide. What is Trauma? Trauma is “a horrific event beyond the scope of normal human experience” (Greenwald, 2007). Some examples of traumatic experiences include: motor vehicle collision; rape; losing a loved one; and childhood abuse, neglect. Some of the many traumatic experiences caused by colonialism include: forced settlement of nomadic tribes; forced relocation from traditional settlements; and removal of children from their homes into residential schools, non-Indigenous foster homes or orphanages in the “sixties scoop”. Historical Trauma The traditional ways of living that fostered resiliency in Indigenous communities were almost completely abolished by colonialism: not only did acts of colonialism cause trauma in Indigenous people, but it also affected their means of coping with and healing from trauma. This is why historical trauma is so enduring and continues to negatively affect generation after generation of Indigenous people today (Linklater, 2014; Haskell & Randell, 2009). Effects of historical trauma: depression and mental illness, sometimes leading to suicide; feelings of hopelessness; addiction as a result of coping by drinking or doing drugs (substance abuse); and sexual and physical abuse including domestic violence. What are Indigenous healing practices? Indigenous healing practices are often based on natural law and the medicine wheel. Natural law is the widespread Indigenous belief in the interconnectedness of nature, animals and man. There are 7 natural laws that provide guidance to human beings derived from the animals that personify them: Love (eagle), respect (buffalo), courage (bear), honesty (sasquatch), wisdom (beaver), humility (wolf) and truth (turtle) (Bouchard & Martin, 2009; Piitoaysis Family School, n.d.). The medicine wheel recognizes four aspects of the individual: the physical, the mental, the spiritual, and the emotional. All of these are taken into account when looking at a person's overall health. These aspects are interconnected and, when balanced, an individual is whole and healthy (McCormick, 1996). The coordinate indicators (north, east, south and west) symbolize the individual's connection with Mother Nature, which is also vital to their health and well-being (Margot, L. & McKenzie, M., 2006). The medicine wheel approach is different from typical western healing practices because it is holistic and considers all aspects of the individual equally, whereas western medicine tends to focus on the individual's physical health in isolation. Some examples of healing practices include: sweat lodges; smudging; and healing circles. Effective healing practices: are informed by Indigenous peoples themselves; are culturally relevant; strengthen bonds with Indigenous traditions and heritage; and foster resilience, which helps those exposed to trauma survive, resist and cope with its destructive effects (Haskell & Randell, 2009). Indigenous healthcare practitioners and helpers in the healing movement draw on: ceremonies; traditional knowledge; and cultural practices (Linklater, 2014). Collaborative Practices: “Two-eyed seeing” The best health outcomes of Indigenous peoples are achieved when they provide leadership in addressing their own trauma and mental health. However, collaboration between mental health providers, who offer more mainstream approaches, and affected communities is also crucial. Learning to see from one eye with the strengths of Indigenous knowledges and ways of knowing, and from the other eye with the strengths of Western knowledges and ways of knowing… and using both these eyes together, for the benefit of all” Eskasoni Mi’kmaq Elder Albert Marshall (Hogue & Bartlett, 2014, pp. 30-31). Trauma-Informed Care and Indigenous healing practices Trauma-Informed Care (TIC) is a determined effort to implement a better approach to treating people that takes into account the impact that previous traumatic experiences have had on an individual’s overall mental health. What is wrong with you?” has shifted to “What has happened to you?” (Rosenberg, 2011). Most Indigenous communities base their healing practices on the belief that connection with nature and community is vital to the overall health of an individual, while TIC stresses the well-being of the individual. Despite this difference, both traditional Indigenous healing practices and TIC share common elements. Both: understand that a traumatized person’s behaviour is a normal response to trauma; embrace a strengths-based approach (as opposed to a deficiency-based approach which focuses on the flaws in the “character” of the trauma survivor); respect the individual and their culture and treat them with dignity (Haskell & Randell, 2009); are holistic in acknowledging the physical, psychological, emotional and spiritual aspects of one’s overall health; and believe there is no “cookie-cutter” path for one’s health and no single “correct” way or approach (Linklater, 2014). In order to effectively treat traumatized people who are Indigenous, people working with them: need to be trained to deliver a trauma-informed approach in an Indigenous context; and must be aware of the interplay of traumatic historical events and social conditions that impact both the community and the individual (Haskell & Randell, 2009; Linklater, 2014). Cultural safety and competence have been identified as key components in providing services to Indigenous people. Without them there are greater chances of inaccurate or inappropriate assessments, inadequate treatment, and risk of re-traumatization (Twigg & Hengen, 2009). Read more about TIC in iE13: Trauma-Informed Care: Trauma, substance abuse and suicide prevention Trauma-Informed Indigenous programs Biidaaban Healing Lodge Pic River Nation, Ontario Round Lake Treatment Centre Vernon, British Columbia Tsow-Tun Le Lum Society Lantzville, British Columbia Urban Native Youth Association (UNYA) Vancouver, British Columbia Restorative justice and historical trauma Restorative justice attempts to repair the harms done to people and relationships through wrongdoing. It tries to restore those damaged relationships and ensure that everyone involved is treated with equal concern, respect and dignity. It is not a return to the past but the creation of a better future (Llewelyn, 2008). People are interconnected and when wrongs are perpetuated it affects not only the victim and offender but the fabric of society. Restorative justice owes much to the insights of Indigenous conceptions of justice. It is a restoration of balance and harmony like that represented by the medicine wheel (Llewellyn, 2008). The Truth and Reconciliation Commission in Canada is one such example of an organization dedicated to restorative justice. References Bath, H. (2008). The three pillars of trauma-informed care. Reclaiming Children and Youth, 17(3),17-21. Bouchard, D. & Martin, J. (2009). The seven sacred teaching of White Buffalo Calf Woman. Retrieved from http://www.btgwinnipeg.ca/uploads/5/2/4/1/52412159/the_seven_sacred_teachings_.pdf Greenwald, R. (2007). EMDR: Within a phase model of trauma-informed treatment. New York: Routledge. Haskell, L. & Randall, M. (2009). Disrupted attachments: A social context complex trauma framework and the lives of Aboriginal peoples in Canada. Journal of Aboriginal Health, 5(3), 48-99. Hogue, M. & Bartlett, C. (2014). Two-eyed seeing: Creating a new liminal space in education. Canada Education, 56(3), 30-31. Linklater, R. (2014). Decolonising trauma work: Indigenous practitioners share stories and strategies. Toronto, ON.: Fernwood Books Ltd. Llewellyn, J. (2008). Bridging the gap between truth and reconciliation: Restorative justice and the Indian residential school Truth and Reconciliation Commission. In Castellano, B., Archibald, L., & DeGagne, M. (Eds.), From truth to reconciliation: Transforming the legacy of residential schools (pp. 183-201). Ottawa, ON.: Aboriginal Healing Foundation. Margot, L. & McKenzie, M. (2006). The wellness wheel: An aboriginal contribution to social work. Paper presented at First North American Conference on Spirituality and Social Work, Waterloo, Canada. Retrieved from http://tapwewin.pbworks.com/w/file/fetch/52896768/LoiselleMcKenzie.pdf McCormick, R. (1996). Culturally appropriate means and ends of counselling as described by the First Nations people in British Columbia. International Journal for the Advancement of Counselling, 18,163-172. Piitoyais Family School.( n.d.). The seven sacred teachings. Retrieved from http://schools.cbe.ab.ca/b244/seven.htm Rosenberg, L. (2011). Addressing trauma in mental health and substance use treatment. The Journal of Behavioral Health Services & Research, 38(4), 428-431. Twigg, R. & Hengen, T. (2009). Going back to the roots: Using the medicine wheel in the healing process. First Peoples Child & Family Review, 4(1), 10-19. Veriest, L. (2006). Allying with the medicine wheel: Social work practice with Aboriginal peoples. Critical Social Work, 7(1). Retrieved from http://www1.uwindsor.ca/criticalsocialwork/allying-with-the-medicine-wheel-social-work-practice-with-aboriginal-peoples
First Nations (status and non-status peoples), the Inuit and Métis are collectively referred to as Indigenous people. Indigenous people in Canada have some of the highest suicide rates in the world, but this is not true for all Indigenous peoples. There are also many communities that have very low rates of suicide. Historically, suicide was a very rare occurrence amongst First Nations and Inuit (Kirmayer, 2007). It was only after contact with Europeans and the subsequent effects of colonialism that suicide became prevalent. Statistics In the 2006 Census, a total of 1,172,790 people in Canada identified themselves as Indigenous people. A National Household Survey in 2011 showed that 1,400,685 people in Canada identified themselves as Indigenous persons. This represents 4.3% of the national population. The 2011 statistics show an Indigenous population increase of 20.1% between 2006 and 2011, compared with 5.2% for the non-Indigenous population (Statistics Canada, 2013). Suicide and self-inflicted injuries are the leading causes of death for First Nations youth and adults up to 44 years of age (Public Health Agency of Canada, 2016). Approximately 46% of all Indigenous children are under 25 years of age (Statistics Canada, 2012). The suicide rate for First Nations male youth (age 15-24) is 126 per 100,000 compared to 24 per 100,000 for non-Indigenous male youth. For First Nations females, the suicide rate is 35 per 100,000 compared to 5 per 100,000 for non-Indigenous females (Health Canada, 2010). Suicide rates for Inuit youth are among the highest in the world, at 11 times the national average. Legacies of Colonization The effects of colonization and governmental policies of forced assimilation continue to cause acculturative stress and marginalization amongst the Indigenous population. These effects can be passed on from one generation to the next; this is referred to as intergenerational trauma. They can ultimately manifest in behaviours which may place individuals at risk for suicide (see risk factors below). Some of the effects of colonization include: Residential schools experiences Forced adoptions and foster care Forced relocation from one community to another Denial of existence as people (as in the case of the Métis Nation) (Kirmayer, 2007) Consequences of these legacies include: an eradication of culture, an erosion of traditional values and a loss of traditional family stability (Elias, 2012). Acculturative stress often occurs when an individual is trying to adjust to a new culture. This stress can manifest through the victim’s feelings of marginality, depression, anxiety, and identity confusion (Leach, 2006). Suicide Contagion & Clusters (excerpt from iE10: Suicide Contagion and Clusters) Many members of Native reserves are closely related and share the same social predicaments. The impact of a single suicide is often felt by the entire community. Because of the closeness of the residents, there is a greater risk of a contagion effect leading to a cluster of suicides (Kirmayer, 2007). These can also manifest as “echo” clusters which refer to clusters that occur over an extended time period after the original cluster (Masecar, 2009). A single death by suicide can resonate for months to come, with individuals taking their own lives in imitation of a prior suicide. It is important to note, however, that not all Indigenous communities have experienced suicide clusters or have regular incidents of suicide. In communities where there is a strong sense of culture, community ownership, and other protective factors, it is believed that there are much lower rates of suicide and sometimes none at all (Kirmayer, 2007). Unfortunately, on some reserves where these protective factors have not been strongly developed, the situation can sometimes be severe. The wounds of historical social and economic upheaval caused by colonization, residential schools, and the “sixties scoop” (and into the seventies where children were taken off the reserves and fostered to mostly Caucasian families) continue to fester in many areas today. This is often called “acculturative stress” and inhibits the growth of a healthy environment. The young will be increasingly vulnerable as Indigenous are the fastest growing ethnic group in Canada. Protective Factors There are certain social conditions which can help create a positive and healthy environment for both a community and its individual members. Chandler and Lalonde (1998) have identified six protective factors which they found in Indigenous communities that had low rates of suicide. These are identified as “cultural continuity” and include: Self-government Land control Control over education Command Police and Fire services Health services Control of cultural activities (Chandler, 2005; CSP, 2003) They also found lower rates of suicide in communities where the indigenous language was widely spoken (Chandler, 2005). A study of various bands in British Columbia indicated that those bands with higher levels of language knowledge (more than 50%) had fewer suicides than those bands with lower levels. [caption id="attachment_765" align="alignnone" width="900"] Image by United Nations[/caption] Risk Factors The following are risk factors which can place an individual at risk for suicide: Depression and other mental illnesses Alcohol and drug dependency Hopelessness Low self-esteem Sexual abuse and violence Parental loss Homelessness (Elias, 2012) The Urban Indigenous Experience Indigenous people who live in cities and towns are an often overlooked segment of our overall urban population. 54% of First Nations (both status and non-status), Inuit and Metis now live in cities and towns (Place, 2012). Many Indigenous people who spend their time living between reserves and cities regard themselves as “boundary spanners” (Letkemann, 2004). For some, this separation from the home community can often heighten feelings of cultural isolation and cause further family instability. Others, however, may adapt to urban life easily. Urban Indigenous people face challenges to their cultural identity which include discrimination and racism, exclusion from opportunities for self-determination and difficulty finding culturally appropriate services. A loss of connection with the land, contact with Elders, and engagement in spiritual ceremonies may contribute to the effects of marginalization and isolation. One consequence for those who live in cities is possible homelessness - Indigenous people are greatly overrepresented in the urban homeless population. Another is disproportionate incarceration: although they comprise only 3% of the Canadian population, Indigenous people make up 22% of those sentenced to custody in the provincial or federal correctional systems (Environics, 2010). Prevention Suicide affects the youth in Indigenous communities more than any other demographic. Suicide occurs roughly 5 to 6 times more often among Indigenous youth than non-Indigenous youth in Canada. Community and Spirituality Suicide prevention is best undertaken by community members, friends and family who understand the social context of the community. Strategies must be formulated in response to local cultural meanings and practices (Wexler, 2012). Some prevention strategies include: Community-based approaches Gatekeeper training School-based suicide prevention programs Means of suicide restriction Peer support programs (Kirmayer, 2007) Community Wellness Strategies: prevention should be the responsibility of the entire community (CSP, 2003). Spirituality has been recognized by many as a key part of wholeness. In western approaches to mental health, the Indigenous concept of well-being and spiritual wellness is largely absent. Spirituality is a key part of wholeness. [caption id="attachment_45983" align="alignnone" width="1024"] Image by Leo Vaha[/caption] Traditional healing practices place healers and community members at the heart of the healing process, and Western practitioners supplement by acting as secondary helpers. This is a more culturally sensitive approach that can be integrated into a diverse range of Canadian Indigenous communities (Wortzman, 2009). An example of a community-based approach utilizing cultural and spiritual methods as healing practices can be found in Alkalki Lake, British Columbia. Dances, ceremonies, and spiritual practices, such as pow-wows, sweetgrass ceremonies, sweat lodges, and drumming circles were used by traditional healers to try and treat the substance-abuse issues of some of its members. The guiding philosophy of this treatment program was: “Culture is treatment, and all healing is spiritual”. The community reduced its alcoholism rate from 95% to 5% in ten years (McCormick, 2000). [caption id="attachment_45982" align="alignnone" width="1024"] Image by Kris Krug[/caption] References Centre for Suicide Prevention. (2003). Suicide among Canada’s Indigenous peoples. Alert #52. Chandler, M. and Lalonde, C. (2008). Cultural Continuity as a protective factor against suicide in First Nations youth. Horizons, 10(1):68-72. Elias, B., et al. (2012).Trauma and suicide behaviour histories among a Canadian indigenous population: An empirical exploration of the potential role of Canada’s residential school system. Social Science & Medicine. 74(10), 1560-1569. Environics Institute. (2010). Urban Indigenous peoples study: Main report. Toronto, ON.: Environics Institue. Retrieved from http://uaps.ca/wp-content/uploads/2010/03/UAPS-Main-Report_Dec.pdf Hallett, D., Chandler, M. and Lalonde, C. (2007). Indigenous language knowledge and youth suicide. Cognitive Development, 22(1):392-399. Health Canada. (2010). Acting on what we know: Preventing youth suicide in First Nations. Retrieved from http://www.hc-sc.gc.ca/fniah-spnia/pubs/promotion/_suicide/prev_youth-jeunes/index-eng.php#tphp Kirmayer, L., et al. (2007). Suicide among Indigenous people in Canada.Ottawa, ON.: Indigenous Healing Foundation. Leach, M. (2006). Cultural diversity and suicide: Ethinic, religious, gender and sexual orientation perspectives. New York: Hawthorn Press. Letkemann, P. (2004). First Nations Urban Migration and the Importance of “Urban Nomads” in Canadian Plains Cities: A Perspective from the Streets. Canadian Journal of Urban Research, 13(1):241-256. McCormick, R. (2000). Indigenous traditions in the treatment of substance abuse. Canadian Journal of Counselling, 34(1):25-32. Olson, R. (2013). iE10: Suicide contagion and clusters. iE:infoExchange. Place, Jessica. (2012). The health of Indigenous people living in urban areas. Prince George, B.C.: National Collaborating Centre for Indigenous Health. Retrieved from http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/53/Urban_Indigenous_Health_EN_web.pdf Public Health Agency of Canada. (2016). Suicide prevention framework. Retrieved from https://www.canada.ca/en/public-health/services/publications/healthy-living/suicide-prevention-framework.html Statistics Canada. (2012). Aboriginal Peoples: Fact sheet of Canada. Retrieved from https://www150.statcan.gc.ca/n1/pub/89-656-x/89-656-x2015001-eng.htm#a3 Statistics Canada.(2013). Indigenous Peoples in Canada: First Nations People, Métis and Inuit. National Household Survey, 2011. Retrieved from http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-011-x/99-011-x2011001-eng.pdf Wexler, L. and Gone, J.(2012).Culturally responsive suicide prevention in indigenous communities: Unexamined assumptions and new possibilities. American Journal of Public Health. 102(5), 800-806. Wortzman, R. (2009). Mental health promotion as a prevention and healing tool for issues of youth suicide in Canadian Indigenous communities. First Peoples Child & Family Review. 4(1):20-27. Related Links Miyupimaatisiiuwin Wellness Curriculum (MWC) MWC is a Canadian school-based suicide prevention program developed in 2000 to promote a wide range of healthy lifestyle choices to counteract the long-term incidence of suicide, as well as substance abuse and violence. It focuses on “wellness” and targets children from kindergarten to Grade 8. This holistic program emphasizes Indigenous culture and was developed with the Cree community to encourage active participation of the family and community. River of Life: Online Course about Indigenous Youth Suicide The River of Life course discusses strategies designed to strengthen the protective factors of Indigenous youth at risk. The material focuses on providing participants who work with Indigenous youth the knowledge to respond to those at risk of suicide.
The River of Life course discusses strategies designed to strengthen the protective factors of youth at risk. The material focuses on providing participants who work with youth the knowledge to respond to youth at risk of suicide. River of Life has been developed with extensive consultation with Indigenous people. The Advisory committee included Elders from Métis and First Nation communities, as well as members from the community who work with Indigenous youth. Participants taking this course have three months to complete the course from the time they log into the course. Participants have taken anywhere from a week to four weeks to complete the course. [expand title="READ MORE" swaptitle="LESS" trigpos="below"] Learning Objectives Explain the current context of youth suicide within Indigenous communities Describe the impact of key historical events that have disrupted cultural continuity and continue to negatively impact Indigenous youth Identify and define factors that either protect or put Indigenous youth at risk of suicide Recognize the warning signs or invitation suggesting that an Indigenous youth might be at risk of suicide Recall the legal responsibilities when working with Indigenous youth at risk of suicide Define the three levels of suicide response: Prevention, Intervention, and Postvention. Audience Ages 18+ This workshop provides information and offers practical approaches for those working with Indigenous youth ages fifteen to twenty-four. The precipitating factors of suicide are different in Indigenous communities than in the general population. Certificate Participants will receive a certificate of completion after completing the online course. [/expand]
Little Cub is a 1-day, discussion-based workshop examining suicide prevention in Indigenous children and communities. The Little Cub Workshop draws heavily on storytelling and oral tradition. It begins by recognizing the unique precipitating factors of suicide in Indigenous communities and moves through to identifying risk and protective factors in children 12 years of age and younger. The workshop finishes by empowering participants with knowledge and tools to transfer the care of a child at risk of suicide to a community-based resource person. It is recommended that participants of this workshop also attend the 2-day ASIST workshop for skills-based suicide intervention training. [expand title="READ MORE" swaptitle="LESS" trigpos="below"] Workshop Topics include: Story of Indigenous Experiences Conversations and Understanding Protective and Risk Factors Responding with Hope Understanding More Audience Ages 18+ This workshop provides information and offers practical approaches for those working with Indigenous children who may be at risk of suicide. The precipitating factors of suicide are different in Indigenous communities than in the general population. Information provided is appropriate for beginner and intermediate social work practice. Certificate All participants will receive a participation certificate upon completing 7 hours of instruction. Special Accommodations If you have any questions, concerns or comments about this workshop please contact the Centre for Suicide Prevention. [/expand]
This workshop is intended for Indigenous caregivers working in Indigenous communities. The Walk With Me workshop draws heavily on Indigenous culture and tradition as it seeks to take participants through the cycle of suicide grief. Indigenous communities are frequently struck with a series of suicide deaths in a short period of time, each of these deaths adding to the already present burden of grief and loss. Bringing community members together for a day of hope and healing builds understanding and strength. This workshop takes the participants on a journey from the past, to the present and looks to the future; it creates a context for people to examine where they are in the grief cycle and how they can move forward to hope. [expand title="READ MORE" swaptitle="LESS" trigpos="below"] It is recommended that participants of this workshop also attend the 2-day ASIST workshop for skills-based suicide intervention training. Workshop Topics: Stories of Indigenous experiences Talking openly about suicide Suicide bereavement model How we heal Developing grief work strategies Self-care Audience Ages 18+ This workshop provides information and practical approaches for understanding and dealing with our own grief and to better understand others’ grief. It is NOT a replacement for grief counselling nor does it train participants to become counsellors. It is recommended that participants wait a period of time after losing a loved one to suicide before attending this workshop. Information provided is appropriate for beginner and intermediate social work practice. Certificate All participants will receive a participation certificate upon completing 7 hours of instruction. Special Accommodations Please contact the Centre for Suicide Prevention if you need specific accommodations. [/expand]
A special feature presentation based on the Centre for Suicide Prevention online course River of Life: Aboriginal Youth Suicide Prevention Bullying is a problem for all kids, but it may be an even bigger problem in the Native American [Aboriginal] community" – Tanya Lee, Indian Country Today, May 30, 2011 Social media sites, such as Facebook, mySpace, Twitter, YouTube, Flickr, Tumblr, Messenger and cell phone texting, have become a large part of the way in which Indigenous youth today “talk” and socialize with each other (Brown, Cassidy, Jackson, 2006). From this, cyber - bullying has become an increasing reality among youth. Research shows that youth who have been bullied are at a higher risk for suicide ideation and thoughts, attempts and completed suicides. Bullying contributes to depression, decreased self-worth, hopelessness and loneliness (Hinduja, Patchin, n.d.). Cyber-bullying is “the use of the internet, cell phones, texting and other technologies to send cruel, untrue, or hurtful messages about someone or to someone that causes harm” (Brown, Cassidy, Jackson, 2009). “Cyber-bullies” use emails, webcams, text messages, chat rooms, camera phones, blogs, websites, etc. to spread derogatory, insulting, excluding or threatening messages and/or images. Most bullying occurs between the ages 13 and 14 then usually decreases around ages 15 to 16. This includes both perpetrators and victims (Brown, Cassidy, Jackson, 2009). “Cyber-bullies” feel that they are anonymous, giving them a sense of power and control that allows them to do and say things they would not normally say in the “real world.” In cyberspace, literally hundreds of perpetrators can get involved in the abuse (Hinduja, Patchin, n.d.). Indigenous youth who are the victims of bullying experience the same feelings of powerlessness and hopelessness as if they were being bullied face-to-face! Because of the all- encompassing nature of the internet and cell phones, it is harder than ever for victims to escape their tormentors. It can happen anywhere—at home, at school, at anytime of the day or night (Brown, Cassidy, Jackson, 2006). In extreme cases, victims have been known to become aggressive and fight back, or to become depressed and attempt suicide. Indigenous youth who have experienced cyber-bullying were almost twice as likely to attempt suicide compared to those who had not (Hinduja, Patchin, n.d.). Cyber-bullying can take on different forms Flaming: Online fights using electronic messages with angry and vulgar language Harassment: Repeatedly sending nasty, mean and insulting messages via email, instant messages or text messages “Dissing”: Dissing someone online; sending or posting gossip or rumours about a person to damage their reputation or friendships. This includes creating websites to make fun of another person (ie. a classmate or teacher) or using websites to “rate” people as prettiest, ugliest, etc. Impersonation: Pretending to be someone else online and sending or posting material to get that person in trouble or danger, or to damage that person’s reputation or friendships Outing: Sharing someone’s secrets or embarrassing information or images online or sending it to others Trickery: Talking someone into revealing secrets or embarrassing information, then sharing it online or sending it to others Exclusion: Intentionally and cruelly excluding—shutting out—someone from an online group Cyber Stalking: Repeated, intense harassment and dissing that includes threats or creates significant fear (Source) Adults or parents don‘t always recognize how devastating cyber-bullying can be for youth. One study shows that only 10% of parents believe their children have been bullied online, while 40% of kids reported they had been victims (Brown, Cassidy, Jackson, 2009). Consider that research shows that 99% of teens use the internet on a regular basis, and 74% of girls aged 12-18 spend more time on chat rooms or sending text messages than doing homework (Shariff, 2005). Because people can be “anonymous” on the internet, Indigenous kids don’t always know who their tormentors are. At an age when peer acceptance is crucial, the internet becomes the perfect medium for adolescent anxieties to play themselves out, sometimes resulting in suicide attempts or loss of a child (Secret Life of Kids Online, n.d.; Shariff, 2005). The Online World (Calgary Police Service, Safe Surf from Youthlink Calgary) The online world can be exciting and addictive. You can keep in touch in with friends and family at any time, and make friends with people anywhere in the world. But be aware and be safe! Social Networking: Facebook, MySpace, Live Journal...all social networking sites that allows users to make their own personal profiles and web pages dedicated to their lives and then share that information through emails, by posting photos and videos, and by expressing personal views. Chat Rooms: There’s a chat room for almost any interest. A chat room is like a giant online coffee shop where users from all over can go to “talk” and meet new people online. Conversations are instant (just like instant messaging) but everyone in the “room” can see it. Instant Messaging: Instant messaging allows you to text messages to family and friends in “real time” so it’s like you’re talking face-to-face. Online Gaming: Online gaming is like playing a regular video game but instead you’re playing online. Gamers can play games from all over the world, play alone or become part of a “team” to defeat enemies or “talk” in real-time with text and voice capabilities. Email: Instead of mailing letters or notes to family and friends, you can write them electronically, hit “send” and have them received almost instantly. File Sharing: File sharing (a.k.a peer-to-peer or P2P technology) allows users to search for and copy files from another computer. Most people use P2P to share or swap music (MP3s) such as Frostwire or the old Limewire, from other computers. 3 Rules for staying safe Remember, not everyone on the internet is there to have a good time. Some people lie about who they are or are there to bully others. Know how to stay safe! Never give out your full name, or real name, or personal information like your home address or phone number Stop, block or tell a trusted adult if someone or something makes you feel uncomfortable or threatened. Treat other users online the way you want to be treated. Don’t use nasty messages, jokes, videos or photos. Suggestions for Solutions to Cyber-bullying The following suggestions are for adults, teachers and users for use in schools and at home: Set up anonymous phone line so students can report cyber-bullying. Have a zero tolerance policy towards cyber-bullying. Educate students and parents about cyber-bullying. Create self-esteem in students through extra-curricular activities. Implement age-appropriate suicide awareness into any anti-bullying program. Don’t respond to mean messages; show it to an adult. Before hitting “send” ask yourself how you would feel if you received the message. Monitor online and offline behaviours of youth. Tell your child you won’t blame them if they are cyber-bullied. Emphasize that you won’t take away their computer privileges (this is the main reason why kids don’t tell adults when they are cyber-bullied). (Brown, Cassidy, Jackson, 2009; Stop Cyberbullying, n.d.) Remember to keep it legal Youth do not always recognize the legal consequences of cyber-bullying. Between 46-50% of youth mistakenly believe they have the right to say anything online because of freedom of expression, leading some to exceed legal behaviour under the Canadian Criminal Code and/or Human Rights Act. (Brown, Cassidy, Jackson, 2009) In Canada, cyber-bullying can be addressed under civil law or criminal law. Under civil law, a person can be charged with defamation (slander or libel); under criminal law, a person can face harassment charges or defamatory libel. Under the Canadian Charter of Rights and Freedoms, freedom of expression is guaranteed “subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society” (Cyberbullying and the Law, n.d.) The U.S. Department of Justice says that crimes related to bullying in Indian country include assaults, extortion, sexual offenses, shootings, murders, stabbings, threats, thefts and vandalism.... “[it is] a gateway behaviour. Bullies go on to commit more serious crimes...consequences for victims are also dire: they include low school achievement, low self-esteem, depression, drug and alcohol use, self-hurting behaviours and suicide.” (American Indian Programs Target Bullying) Case Study “Being Virtually Bullied” (Windspeaker AMMSA “Kind and Considered Response to Grown Up Experiences,” August 2011) Dear Auntie: I thought I had good friends, but recently on Facebook there have been a few people talking about me and spreading bad rumours. I don’t want my friends and family to believe what these people are saying about me, but if I answer the rumours on Facebook the comments and lies about me just get worse. I feel like things are getting out of control and I am powerless to stop it. What should I do? I’m very upset about this. Signed, Virtually Bullied Auntie’s Answer: Whether you are in a small village or living in the urban rez there is a wounded part of our community....being different, new or returning to the community, single or educated can be among the many reasons to be a target... rumours are not cultural. Stay out of harm’s way and surround yourself with family and friends that show you unconditional love and respect...perhaps as for support from people or service providers to organize workshops on how to handle cyber bullying. Resources How the Moon Regained Her Shape by Janet Ruth Heller – This is a teaching story about how to overcome bullying. The once-brilliant moon is bullied by the mean- spirited sun and becomes sullen, unable to dance across the sky. A comet, a positive warrior figure, embraces the moon and takes her to a healing woman who teaches her how to overcome the sun’s harsh words with the help of caring friends and inner strength. Fatty Legs, A True Story by Margaret Pokiak - Fenton and Christy Jordan - Fenton – This is a true story about a young Inuvialuit girl named Olemaun, later named Margaret Pokiak. Olemaun grew up in Banks Island in the Northwest Territories where her family lived by hunting and trapping the land. From age 8 to age 12, Olemaun was sent to a residential school in Aklavik. She was targeted by a nun who would bully her and embarrass her in front of everyone. Olemaun’s story is about empowerment, courage, endurance and overcoming oppression at such a young age. Native American Youth Narrates Suicide Prevention – Indian Health Service Creating Caring Communities Bully- Proofing Your School – This is a 3-year school-based pilot program created by the Indian Health Service and Watersmeet Township to reduce the violent and bullying behaviours of Native students. The program has expanded to include K-12 schools serving the Chippewa, Oneida, Stockbridge-Munsee, and Potawatomi nations (refer to “American Indian Programs Target Bullying” in bibliography). Online Sources Be WebAware - Cyberbullying Bullying Canada Bully Free Alberta Be Free Cyberbullying Team Heroes Honouring Life Network References American Indian Programs Target Bullying. Retrieved November 24, 2011 from http://indiancountrytodaymedianetwork.com/2011/05/30/programs-by-indians-target-bullying-35000 Brown, K., Cassidy, W., and Jackson, M. (2006). Cyber- bullying: Developing policy to direct responses that are equitable and effective in addressing this special form of bullying. Canadian Journal of Educational Administration and Policy,57. Retrieved September 20, 2011 from http://umanitoba.ca/publications/cjeap/articles/brown_jackson_cassidy.html Brown, K., Cassidy, W., and Jackson, M. (2009). You were born ugly and youl die ugly too: Cyber-bullying as relational aggression. Education Journal: Special Issue on Technology and Social Media, Part I, 15(2). Retrieved September 20, 2011 from http://ineducation.ca/ineducation/article/viewFile/57/539 Calgary Police Service. Safe Surf from Youthlink Calgary. Retrieved December 8, 2011 from http://www.youthlinkcalgary.com/safesurf/layout/set-print/What-s-Online Cyberbullying and the Law Fact Sheet. (n.d.) Retrieved September 27, 2011 from http://www.media-awareness.ca/english/resources/educational/teaching_backgrounders/cyberbullying/cyberbullying_law2_h4.cfm Hinduja, S., and Patchin, J. (n.d.). Cyberbullying Research Summary: Cyberbullying and Suicide. Cyberbullying Research Center. Retrieved September 20, 2011 from http://www.cyberbullying .us/cyberbullying_and_ suicide_research_fact_sheet.pdf Indian Health Service. IHS Public Service Announcement—Native American Youth Narrates Suicide Prevention. Retrieved November 29, 2011 from http://www.ihs.gov/PublicAffairs/DirCorner/index.cfm?module=blog311p1 Mesa Police Teen Connection—Texting to Sexting. Cyber Bullying. (n.d.) Retrieved November 24, 2011 from http://www.mesaaz.gov/police/TeenConnection/CyberBullying.aspx Secret Life of Kids Online: What You Need to Know (2011). Retrieved September 20, 2011 from http://www.parenting.com/article/kids-social-networking Shariff, S. (2005). Cyber-Dilemmas in the New Millennium: School Obligations to Provide Student Safety in a Virtual School Environment. McGill Journal of Education, 40(3), 457-477. Stop Cyberbullying: Project Safe Childhood (n.d.). U.S. Attorney’s Office, U.S. Department of Justice. Retrieved September 27, 2011 from http://www.justice.gov/usao/ma/childexploitation/psc/Stop%20Cyberbullying.pdf Windspeaker AMMSA. Kind and Considered Response to Grown Up Experiences [Column]. Vol. 29, Issue 2, 2011 Retrieved November 24, 2011 from http://www.ammsa.com/publications/windspeaker/kind-and-considered-response-grown-experiences-colum
There has been a veritable avalanche of hockey memoirs published in the last few years that foreground the critically important topic of men’s mental illness. To be clear, these books are chiefly accounts of the lives of these men in professional hockey, but underlying issues such as Post Traumatic Stress Disorder (PTSD), alcohol and substance abuse, depression, and anxiety appear as prominently in the player’s career trajectories as Fall training camp or the National Hockey League (NHL) draft. A quick scan of these titles may give you the skewed impression that hockey is bad for your mental health, or even prompt the question: What’s up with Canada’s game? Of course this is an exaggeration. Any sports fan who reads will tell you that the vast majority of hockey books published are as formulaic as the ones I read as a kid. In fact, some of the first “adult” books I ever read as a boy were about or by hockey stars - straightforward stories of triumph. Most are, by and large, exciting, innocent adventures of determined and talented players advancing from back-country frozen ponds, surmounting uncomplicated obstacles, and ultimately finding fame in the NHL. This literary landscape changed dramatically, however, with the publication of two eye-opening and ground-breaking autobiographies. Sheldon Kennedy’s Why I Didn’t Say Anything (2006) bravely addressed child sexual abuse when he disclosed the sexual crimes of his predatory coach, Graham James. In 2009, Theoren Fleury recounted experiences with this same monstrous coach in his book, Playing with Fire. The impact of Kennedy’s and Fleury’s books on the NHL - and on hockey at all levels - was absolutely seismic. These stories also had a profound effect on Canadian society in general, as Kennedy’s descriptions of the abuse - and how he dealt with the trauma by abusing alcohol and drugs during his NHL days in the 1990s - was powerful and, ultimately, a game-changer in child care and other areas. His story opened the door for the implementation of many positive measures in hockey, including a new tolerance for writing about and discussing previously stigmatized subjects. In the years since, a sliver of the already small niche of hockey biographies has been cutting-edge in the call to attention they have solicited for mental health issues. A sliver of the already small niche of hockey biographies has been cutting-edge in the call to attention they have solicited for mental health issues. More recent books by Jordin Tootoo, All the Way (2014), Clint Malarchuk, The Crazy Game (2014), Patrick O’Sullivan, Breaking Away (2015) and a biography of the late enforcer Derek Boogaard, Boy on Ice (2014) have similarly shone light on the darker side of playing hockey. While hockey itself certainly does not cause mental illness, like any segment of society there are vulnerable NHL players who are susceptible to it. Men do not typically talk about things like weakness or vulnerability, and they don’t usually discuss these topics with their friends, but we need to. Hockey is an immensely popular and influential game, so the potential for conversation surrounding men’s mental health reaching a wider audience is massive. These players writing about their experiences is doing just that, and it is a huge deal! Men do not typically talk about things like weakness or vulnerability, and they don’t usually discuss these topics with their friends, but we need to. A closer examination of many of these books reveals that they are not your average superstar memoirs, nor are they written by the biggest names in the sport. With the exception of Malarchuk, who had success as a goalie in the 1980s, or Fleury who was a top-scorer with the Calgary Flames and New York Rangers, none of them was a famous player. Although it is a major feat to make it to the NHL - and I am not implying anything to the contrary - these are the stories of hockey’s “everyman.” I challenge that this makes these stories even more important because they suggest that any player can be at risk in a hyper-masculine environment (which, in Canada, might better be labelled the hyper-masculine environment). We may find it hard to relate to the megastar story of a Gretzky or a Crosby, but we can more easily identify with the plight of these more regular NHL players. This is hockey stripped of any glamour or hype, not the realized boyhood dreams of a life in the pros. It is hockey, but presents the game as lived by flesh and blood suffering men. It is hockey, but presents the game as lived by flesh and blood suffering men. [caption id="attachment_15945" align="aligncenter" width="1024"] Image by R.G. McFadden[/caption] The battle scars of “goon” Derek Boogaard, who suppressed his pain in silence by self-medicating to the extreme, symbolized the exaggerated, muted, dysfunctional behaviours that some of us men demonstrate. He has dreams of being recognized for his hockey talents - the ultimate dream of all enforcers - but he is resigned to fighting, which is his real job on the ice. The results of his resignation were terrible, most notably in the experience of his community. Boogaard was the last of a dying breed, as the role of the enforcer has been increasingly phased out from the mid-2000s onward. But there was still enough demand for his fists in the late 2000s to find continuous employment. An autopsy performed on his breain after his death – a result of huge amounts of painkillers and alcohol – revealed major brain decay, a potential indicator of earl on set dementia had he lived longer than his short 28 years. He was one of three enforces who lost their lives in the summer of 2011. The other two, Rick Rypien and Wade Belak, died by suicide due to their untreated depression, substance abuse, and inexorable physical pain. Read more When a man is dislocated from familiar surroundings and has lost his social supports, he can be vulnerable. Jordin Tootoo was raised in Rankin Inlet, Nunavut, a community rife with alcoholism and family dysfunction, as well as the generations-old historical trauma – the consequences of colonialism – of an Indigenous living in Canada. Hockey was a rare outlet for escape and Tootoo excelled at it, becoming a local sensation before heading south to play junior hockey in Brandon, Manitoba. Despite being somewhat of an adolescent celebrity with the Brandon Wheat Kings, he was adrift in a strange environment and disconnected from his community. He experienced racism for the first time and had feelings of isolation that he suppressed with alcohol, partying, and local girls. Nunavut might have had its major problems, but it was still his home. [caption id="attachment_15946" align="aligncenter" width="1024"] Image by Paul Nicholson[/caption] Tootoo triumphed on the ice and made it to the pros, becoming the first ever Inuk to do so. His inner fragility worsened, however, until he hit rock bottom a few years into his career. Fortunately, in 2008, he realized that he needed help, and accepted the National Hockey League Players Association (NHLPA) directive of rehabilitative treatment. He was able to re-connect with his Inuit heritage, and his culture became a source of strength. He is still active in the NHL today, playing sober and living well as a New Jersey Devil. It has become widely accepted in mental health circles that childhood trauma often manifests itself through negative consequences in adulthood. Patrick O'Sullivan's childhood was a nightmare as he experienced the physical abuse and mental torment from "a hockey dad from hell," John O'Sullivan, whose relentless drive to get his son into the NHL was absolutely outstanding. This is the familiar story of an over-involved parent - himself a failed minor league player - but taken to horrific extremes. At age 8 or 9 he would wake Patrick to do punishing exercise routines more suitable for a player twice his age, or would make him run behind the car for miles and miles when they drove home from games. John’s overbearing behaviour toward his son’s coaches meant the entire family had to move almost every year to various towns in Canada and the United States to play with different teams. John went to absurd lengths to get his son into the professional ranks, and there was seemingly no scheme that was too far fetched. John forged his birth certificate at the age of 13 to get him on the U.S. under-15 squad, and at 14 had him playing with 20-year old grown men in an Ontario Senior League. This manic dad was able to manipulate and con those in charge and have Patrick “playing up” with older, more developed players. To him, Patrick was “hockey playing chattel who would eventually pay off.” It was clearly evident that young Patrick had natural hockey talent, but a decade of his dad’s brutality all but snuffed out any true passion he had left for the sport. By the time he reached the NHL entry level draft in 2003 and his story was common knowledge on the sports channels, potential hockey suitors had already pegged him as having “baggage.” Although he was by then free from the control of his demanding dad, he was labelled a “problem kid” that no team in the NHL, with its historical aversion toward mental health issues, was willing to tackle. O’Sullivan had a number of lacklustre seasons but, in truth, his career never had a chance. He unknowingly, suffered from PTSD, which played no small role in ultimately sidelining him. Only now, in retirement, is he seeking and getting the help and support he needs to deal with his childhood trauma. Clint Malarchuk’s tale is the perfect example of a young man suffering from mental illness that progressed to the point of career-ending debilitation. He suffered from both Obsessive Compulsive Disorder (OCD) and Major Depressive Disorder (MDD). A goalie in the 1980s and 1990s with Quebec, Washington and, later, the Buffalo Sabres, he achieved widespread notoriety for having his jugular vein cut open by an opponent’s skate during a televised NHL game in 1989. Millions continent-wide watched in horror as Malarchuk was rushed off the ice, trainers and attendants furiously trying to stop the surging blood. He barely survived. The “play through pain” work ethic took hold, however, and he was back in the net within a couple of weeks. His close brush with death, however, would dog him for years to come, and his depression and OCD worsened in the ensuing years. It became so bad in the early 1990s, and his drinking to combat it so excessive, that he lost his job in the pros. He was relegated to the minors before eventually retiring; he went into coaching. His drinking as a form of self-medication while he was still playing caused the NHLPA to pressure him into rehabilitation. This assistance was not sustained for long. It was the first of many stints in rehab, followed by repeated periods of sobriety and infrequent binges. Despite all these circumstances, he maintained his belief in his own self-reliance and ability to work it out for himself. Clearly, his attempts at self-treatment were not working. In 2007 his mental pain became so intense that he threatened to kill himself. In 2007 his mental pain became so intense that he threatened to kill himself. He ended up in a psychiatric ward. A year later he attempted suicide by shooting himself in the mouth, but somehow miraculously survived. His suicide attempt precipitated the more stable recovery that he enjoys today. The memoir ends with no resolution or conclusion, just the realistic assertion that his life continues to be a “work in progress”. He confesses that it has been a decades - long pursuit with many setbacks and failures, but, finally, he feels that he has a handle on his demons. I must reiterate that these are important books, and I highly recommend reading any or all of them. There are others, too, including a new one by Reggie Leach titled The Riverton Rifle. He was the celebrated Indigenous sniper on the 1970s Philadelphia “Ferocious” Flyers, whose career was all but eclipsed by alcoholism. Like the books mentioned above, it is one that I think transcends the genre of the mere hockey memoir. All are meaningful testimonies of pain that offer us an uncensored window into both the hockey world and the struggles of men who battle mental illness. They invite all men, the average Joes who love hockey and hold sacred the Canadian Saturday night winter ritual, to shatter the stigma associated with mental illness and break to pieces the silence that surrounds it. For some men these stories are the source by which they learn more about mental afflictions, while others who might suffer from similar disorders are afforded an opportunity to relate to men with whom they share similar struggles. These books are reaching the audience who may benefit the most from them - namely other males - and for that we are grateful for the hope, inspiration, and conversation surrounding the topic of men’s mental health. And to that, I can only say: Game on! ...some of the first “adult” books I ever read as a boy were about or by hockey stars - straightforward stories of triumph... innocent adventures of determined and talented players advancing from back-country frozen ponds, surmounting uncomplicated obstacles... This literary landscape changed dramatically...