Hannah Rahim
CEO
STEM Fellowship
The need for community-driven phenomenological research to address the suicide crisis among Indigenous peoples in Canada
Connected Conference Theme:
Biography:
Hannah is an Associate at Boston Consulting Group with an interest in the intersections between population health, management, and social justice. She completed her Bachelor of Health Sciences degree at the University of Calgary as a Schulich Leader Scholar, receiving the President’s Award for Excellence in Student Leadership and the Cumming School of Medicine Gold Medal upon her graduation in 2020. During her degree, she conducted several health research projects on topics including birth tourism, medical cannabis and transplant immunology and has published peer-reviewed papers in academic journals.
Hannah is passionate about social impact and served as the CEO of STEM Fellowship – a national charity that works to increase diversity and educational innovation in STEM through mentorship and experiential learning. She has also interned with the Office of the United Nations High Commissioner for Human Rights, where she conducted research on the rights to water and sanitation.
Proposal Inspiration:
I was inspired to propose policy recommendations relating to the Indigenous suicide crisis, as it is one of the many longstanding consequences of Canada’s history of cultural genocide of Indigenous peoples. Recent discoveries of over 1,300 unmarked graves at the sites of four former residential schools in Canada are a harrowing reminder of the widespread and systematic abuse of Indigenous peoples during colonization. This reprehensible treatment of Indigenous peoples contradicts principles of multiculturalism that Canadians value as part of our national identity. The Indigenous suicide crisis is of critical importance, for it reflects Canada’s failure to rectify our past injustices towards Indigenous communities.
Need/Opportunity for Action:
Colonization of Indigenous peoples left a legacy of violence and abuse, reduced social cohesion and collective identity, loss of language and culture, fragmented political and economic structures, and intergenerational transmission of trauma [1–3]. These experiences have been accompanied by profound socioeconomic inequities in income, employment opportunities, housing, and food security as well as pervasive systemic racism [2,4–6]. As a consequence of these factors, Indigenous populations have the poorest health outcomes in Canada [7].
Suicide is a leading cause of death for First Nations, Métis and Inuit peoples – the main Indigenous groups in Canada [8]. The rate of suicide is three times higher among First Nations, two times higher among Métis, and nine times higher among Inuit, compared to the general population in Canada [1]. First Nations youth face a suicide rate five to seven times higher than non-Indigenous youth, while the rate of suicide among Inuit youth is eleven times greater than the national average [9]. 24% of First Nations living off-reserve, 23.5% of Inuit and 19.6% of Metis individuals reported ever having suicidal thoughts [10].
Existing literature demonstrates that suicide in Canadian Indigenous populations is associated with socioeconomic disadvantage [8,11] disruptions to family life [11,12] cultural stress (including loss of land, suppression of belief systems, racism and weakening of social institutions) [11], a history of abuse [13–15], depression and psychological distress [12,14–18] and substance abuse [13,14,17,19,20]. Familial exposure to the residential school system has been strongly associated with lower self-rated health and an increased frequency of suicide attempts [21–23]. Protective factors against suicide have also been identified, including cultural continuity [24] hunting [15] frequent church attendance [13,17] and academic achievement [13]. Contextual, cultural, structural and social factors have been shown to have a larger impact on Indigenous suicides than individual-level factors, but predominant prevention approaches continue to focus on the latter [11,19,25].
Chandler and Lalonde [24,26] discovered a high variability between suicide rates among First Nations in British Columbia: some communities experienced no suicides over a 14 year period while others faced rates up to 800 times the national average. The authors observed an inverse correlation between suicide rates and community involvement in practices to preserve cultural identity [24,26]. They suggested that when the culture of a group is threatened, the resulting loss of shared values and ties to the past can decrease an individual’s commitment to their future well-being, which can increase suicide risk [24,26]. Additional studies that compare Indigenous communities across Canada to identify protective factors against suicide are needed to validate these findings and understand how they can inform suicide prevention interventions. Although many papers mention suicide as a problem in Indigenous communities, there is a knowledge gap regarding culturally-relevant interventions that can address the issue [27].
While a few investigations employed qualitative methods such as focus groups or semi-structured interviews [18,19,28,29] the majority of the literature consists of epidemiological investigations utilizing surveys or medical charts to quantify the strength of correlations between suicide rates and various risk factors [12–17,20]. Suicide is often studied from a biological lens as a psychiatric issue that results from causes that exist within individuals [11,30]. This framing of suicide as a personal issue is discordant with Indigenous values of interdependence with their community, ancestors and environment and does not consider how suicide is shaped by situational and social factors including history, politics, identity, culture and power [11,29,31,32].
The literature also lacks narrative accounts of Indigenous perspectives on self- and cultural-continuity, culturally-relevant suicide mitigation strategies and the ways in which traditional healing can reduce suicide prevalence. One of the few research articles written by an Indigenous author emphasizes that the dominant notion of suicide as a direct consequence of mental illness obscures the impact of structural violence and societal problems on the suicide crisis [11,33].
Proposed Action:
Suicide in Indigenous communities needs to be recognized as a public health priority and allocated comparable resources to other major public health issues [34]. In particular, policies should be enacted to support funding of suicide prevention research through a lens that amplifies the voices of Indigenous communities. Although Indigenous health policy frameworks in Canada have recognized the importance of structural dimensions of suicide in Indigenous communities, most research approaches have not yet encompassed these dimensions [11].
Many interventions in Indigenous communities place external health professionals in positions of paternalistic authority, threatening communities’ autonomy and self-determination [35]. These interventions are disempowering to communities and the imposition of Western knowledge systems is reminiscent of colonial efforts [35]. To ensure that future interventions respect communities’ priorities, approaches and knowledge systems, further research surrounding suicide in Indigenous communities is critical.
It is recommended that phenomenological research be used as a tool to explore how Indigenous participants perceive mental health in their communities and to understand the role of Indigenous culture and knowledge in addressing the suicide crisis. Phenomenology is a form of qualitative research that seeks to understand individuals’ lived experiences, emphasizing the subjective meaning of an experience to a group of people over broad and generalizable findings [36,37]. Phenomenology can be useful to understand suicide in the sociocultural context of Indigenous communities rather than relying on standard biopsychosocial frameworks [11]. Phenomenology can also allow for the needed focus on personal stories and viewpoints of Indigenous participants, separated from researchers’ existing knowledge and assumptions [36,37].
Indigenous perceptions of health are holistic, incorporating mental, physical, emotional and spiritual health as well as an interconnectedness with nature [29,31,32,38]. Phenomenological approaches will be useful to capture the multidimensionality of Indigenous in experiences, to a depth not possible with reductionist approaches used in previous epidemiological studies of suicide [25]. Due to the use of oral storytelling as a method to capture data, phenomenological approaches also align with Indigenous knowledge-sharing traditions [37].
Phenomenological approaches offer the opportunity to investigate how upstream protective factors like cultural continuity can mitigate suicide. Highlighting these positive characteristics of communities with low suicide rates can facilitate the creation of interventions based on existing strengths of communities. This strengths-based approach aligns with Indigenous strengths-based constructions of health [39].
In light of Canada’s shameful history of unethical research on Indigenous peoples [40] it is imperative that research initiatives be developed through long-term partnerships with Indigenous communities. Policies to ensure ethical conduct of research and provide Indigenous communities with ownership over their data will be key to inform this research. Existing frameworks such as the First Nations Mental Wellness Continuum [41] should be considered in designing research approaches. Additionally, current funding models that require institutional affiliation to receive funding serve as a barrier for Indigenous organizations to obtain funding. Eligibility guidelines should be modified to ensure equitable access to research funding for Indigenous organizations [42].
In summary, phenomenological research to understand suicide in the context of Indigenous culture and experiences is essential to tackle the suicide crisis. Stark inequities in Indigenous health outcomes will persist unless we change the status quo of Indigenous suicide research.
