WARNING: This story contains sensitive subject matter, including suicide and self-harm, that could be triggering for some readers.
HIAWATHA FIRST NATION — As soon as Jaclyn Carr stepped inside the front door of the bungalow where she lives with her parents, something felt different.
“It didn’t feel like my house anymore,” she said, recalling an evening nine years ago that marked a desperate point in her lifelong struggle with mental health. “I just felt an overwhelming sense of pain and grief.”
She had arrived back in her community of about 330 people near Peterborough after spending a pleasant dinner with a friend.
Suddenly, the then-18-year-old social work student was struggling to breathe.
Around midnight, Jaclyn’s mother, Hiawatha First Nation Chief Laurie Carr, was babysitting at her son’s house nearby when her phone rang. Jaclyn had attempted suicide.
The mother rushed home to find her daughter in mental and physical anguish.
“I can’t take it away from her,” she thought at the time. “I can’t make her better.”
Now 28, Jaclyn recalls her decision that night as a surrender.
“I just knew that that was what I wanted to do and what I was going to do and I just didn’t have enough in me to say, ‘No, you’re not.’”
If you are thinking of suicide or know someone who is, there is help. Resources are available online at crisisservicescanada.ca or you can connect to the national suicide prevention helpline at 1-833-456-4566, or the Kids Help Phone at 1-800-668-6868.
Nearly a decade later, Jaclyn has found resilience in traditional drumming and singing. But for many other First Nations youth in Canada, who suffer from some of the highest suicide rates in the world, culturally sensitive counselling and community healing practices remain inaccessible.
“I feel like my roots are reconnecting into the soil because they’ve been pulled out,” she said. “I’m closer to purpose.”
An analysis of key mental health indicators for First Nations youth —— including antidepressant prescriptions, suicide attempts, self-reported disorders and access to support —— reveals a strained system of care failing to meet the needs of desperate young people.
The suicide rate for First Nations people under age 25 was roughly six times higher than the rate for non-Indigenous Canadians of the same age between 2011 and 2016, according to national data. The rate for young First Nations women and girls was 11.5 times greater.
“We’re looking at children as young as eight years old in Indigenous communities … that are now committing suicide,” said Tristen Schneider, an Anishinaabe-Dene youth advocate from Shawanaga First Nation in Ontario and former mental health program co-ordinator at Chiefs of Ontario.
Schneider said it is often impossible to find help that incorporates a traditional First Nations approach, the result of a cultural disconnection that has impacted generations of First Nations people in Canada.
“There’s a lot of unprecedented trauma that still needs to be dealt with in a lot of our communities,” she said. “Part of the reason there is a lack of cultural support is that a lot of people haven’t had that ability to understand the full teachings yet.”
The recent revelations of more than 1,000 remains of children found in unmarked graves around former residential schools across Canada are having a reverberating effect for young Indigenous people that could make matters even worse, said Jeffrey Ansloos, an assistant professor at the University of Toronto and member of Fisher River Cree Nation.
“It’s had profound ripple effects in every community in the country and has utterly changed the lives of thousands and thousands of Indigenous people.”
Amy Bombay is an Anishinaabe associate professor at Dalhousie University from Rainy River First Nation whose research shows First Nations individuals who have parents or grandparents who attended a residential school have an increased risk for suicidal ideation, suicide attempts or depressive symptoms.
“All of the mental health inequities we see today are in part due to intergenerational effects of various aspects of colonialism … including ongoing racism against Indigenous peoples,” she said. “Even if it’s not explicit racism, the support services that are available might not be culturally relevant to all those students.”
The number of mental health-related drug claims for Indigenous youth under 18 nearly tripled from 2009 to 2019. There were more than 42,000 claims in 2019, up from 14,000 in 2009, according to data obtained from Indigenous Services Canada’s First Nations and Inuit Health Branch.
By far the most commonly prescribed type of these medications are selective serotonin reuptake inhibitors (SSRIs), a class of antidepressants often used for anxiety and depression and designed to increase serotonin in the brain.
They are most often recommended for children in combination with talk therapy. But Indigenous leaders and mental health researchers say these services are often lacking or unavailable.
“I find it really harrowing that there are pharmaceuticals being prescribed in the absence of real substantive forms of clinical assessment of young people,” said Ansloos, who also holds a Canada Research Chair in Critical Studies in Indigenous Health and Social Action on Suicide. “It’s honestly easier to think about prescribing pills in a community than thinking about what it would take to get comprehensive mental health care in that community.”
Even when mental health services are offered, they often lack the cultural and historical understanding needed to have real impact, say leading researchers.
“Access doesn’t just mean that you have a family doctor in every community or you have a clinic in every community,” said Dr. Cornelia (Nel) Wieman, acting deputy chief medical officer of First Nations Health Authority in British Columbia.
“We absolutely know that the health care system is rife with racism, discrimination, poor treatment,” she said. “It’s almost like you have to have that little bit of strength and resilience just to persist, to find … someone who is culturally safe, who understands the context.”
Angela Mashford-Pringle, the first Indigenous Health Lead at the University of Toronto’s Dalla Lana School of Public Health, said bringing youth back to the land where they can reconnect with their culture and language holds the greatest promise for healing.
“That is the most transformative.”
Jaclyn Carr didn’t have access to the kind of treatment and healing she needed when she first sought support.
From a young age, she said she struggled. Inexplicably sad by the age of 10, she was told by her pediatrician she would grow out of it. By 15, she was diagnosed with anxiety. At 18, the age she first tried to end her life, she was diagnosed with depression. While in university in 2014, she was diagnosed with post-traumatic stress disorder (PTSD).
The medical care she received from psychologists and psychiatrists often left her feeling misunderstood and less forthcoming.
“I kind of just avoided talking to doctors because they kind of scared me.”
By age 20, Jaclyn had survived the loss of family members, bullying, multiple sexual assaults, overdoses and eating disorders. In the two years that followed, she attempted suicide two more times, she said.
She’s far from alone.
A survey of more than 2,000 post-secondary students aged 17 to 24 across Canada —— conducted by global trend-tracking firm RIWI on behalf of this IJB/Star investigation —— shows First Nations respondents have higher rates of self-reported PTSD, substance use and depression than any ethnicity surveyed.
The findings —— gathered between March and October of last year —— show one in five of the 161 First Nations students surveyed reported mental health struggles such as PTSD and substance abuse, compared to less than 10 per cent of all ethnicities surveyed in Canada.
More than a third of First Nations respondents reported suffering from depression, compared to 25 per cent among all respondents, the data show. Rates of self-reported eating disorders were also higher, with 22 per cent of these First Nations students reporting the disorder compared with 12 per cent of all respondents.
Despite these numbers, less than a third of First Nations post-secondary student respondents sought help at university or college —— the smallest proportion of any ethnic group.
And while 30 per cent of the First Nations post-secondary students reported that counselling was helpful when they received it, overall they were more likely to report feeling unsupported in their counselling relative to other ethnicities.
When her first attempted suicide brought her to the hospital, Jaclyn said she lied to her doctors so she could get discharged faster.
The most pivotal breakthrough happened outside of a doctor’s office, she said.
She rediscovered drumming —— after abandoning it as a child —— while working in the community. It was like a weight had lifted.
“I can be medicated on how many medications, but I feel like when I started drumming and when I started learning the teachings, I just felt more like I was actually healing,” she said.
“Drumming just kind of is my way to say, ‘I’m here, I’m present,’ and then I have that voice that I never got to use before,” Jaclyn said. “Before that, it was just finding vices to fill in the void —— whether it was drinking, whether it was doing impulsive things.”
When suicidal behaviour among members of Cowichan Tribes in B.C. increased more than 2.5 times between 2007 and 2012, tribal leaders declared a local state of emergency. They also invited Emma Elliott-Groves, a social worker and assistant professor at the University of Washington, who is originally from the community, to find out why.
While western concepts of mental health focus on “individualism and autonomy,” Indigenous practices value “extended kin relations, authority vested in elders, and dynamic notions of time and space,” according to Elliott-Groves’ 2019 study published in the Journal of Ethnic & Cultural Diversity in Social Work.
But by relying on these Western concepts, most medical professionals use therapies or treatments that may not be beneficial to their Indigenous patients, the study found.
To conduct their work, researchers engaged youth and their families in a nature walk led by a medicine person and an art therapy session with Cowichan families. They also did in-depth interviews asking youth about their relationship to their community, to gain an understanding of their present and past psychiatric illnesses, substance abuse, family connections and religious or spiritual beliefs about the afterlife.
In an interview, Elliott-Groves said the narrative storytelling approach helped researchers conduct mental health assessments “in a way that highlighted Indigenous concepts of self, and engaged Indigenous teaching and learning strategies.”
Experts on Indigenous youth mental health often point to the White Mountain Apache Tribe Reservation, a community of 16,000 in eastern Arizona, as a leader in youth suicide prevention.
A cluster of youth suicides in 2001 prompted tribal officials to order the community and its service providers to report suicidal behaviour to a first-of-its-kind central database.
The surveillance system can trigger referrals to treatment, in-person interviews with mental health specialists and classes that teach problem solving and coping skills.
The suicide prevention plan also includes teaching students from kindergarten, culture and values, and elder-led field trips to sacred sites.
Between 2001-2006 and 2007-2012, the overall suicide rate in the community dropped nearly 40 per cent, including a nearly 25-per-cent reduction among youth aged 15-24, according to a 2016 paper published in the American Journal of Public Health.
In early September, Jaclyn stepped in front of more than 100 Hiawatha members carrying her drum, which was passed down from her mother. They had gathered to watch the unveiling of a new, state-of-the-art cultural centre in the community. It will make room for a new mental health facility down the road, with plans for both traditional and Western treatments from Indigenous practitioners, elders, social workers and psychologists.
She sang the Seven Grandfathers song, which contains seven teachings passed down by her ancestors. The teaching that most resonates with Jaclyn is Aakdehewin, or bravery.
“Going through what I’ve gone through and making the decision every day to keep going and keep pushing … To live a life that I want to live,” she said.
Chief Carr sees her daughter’s path forward through a cultural lens.
“We’re very lost … in regards to culture and peace and now we’re bringing those pieces back,” she said. “One of our teachings is that we all hope to live the life Creator intended for us. She’s getting there to live her best life.”
Jaclyn continues to heal. She is sober, and taking time off work to focus on her mental health.
“I can finally speak, singing songs to heal my wounds,” she wrote in a poem describing her journey. “The sun rises upon me, showing my way home.”
With files from Andrew Bailey and Morgan Bocknek, Toronto Star; and Candice Lipski, University of British Columbia
This story was also published in the Toronto Star.
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