Institution building and suicide prevention

Over the past two days I have been facilitating a conference of First Nations health directors from around British Columbia. Every year or so, these folks gather to share ideas, learn about emerging trends and participate in policy development with government. When they go back home, these guys run health care systems in small First Nations communities, battling against many issues that affect First Nations health resulting in higher than average rates of diabetes, suicide, abuse, accidents, HIV/AIDS, communcable diseases and many other preventable causes of death and illness. At times I think the pressure of applying band-aids to the complex and systemic problems facing some communities can be immense and the challenges must seem insurmountable at times.

But today, I saw something that looks like magic. In the conference we had a presentation on a paper written in 1998 by two psychologists at the University of British Columbia, Dr, Michael Chandler and Christopher Lalonde. The paper is called “Cultural Continuity as a Hedge Against Suicide in Canada’s First Nations” and I think it’s one of the most important papers I have ever read.

The authors look at the role that cultural continutity plays in supporting invidual self-identity, especially among youth in BC Frist Nations. It works from a well-known correlation between supportive communities, healthy individuals and low suicide rates, but the reall contribution of the paper is that it outlines a course of action communities can take to dramatically lower rates.

To do this, the authors decided that they would try to identify factors that actually represented “cultural continuity” in communities and they settled on six:

• Land claims: First Nations were active in establishing claims for Aboriginal rights and title.


• Self government: a community has had some success in establishing their rights to controlling their economic and political independance.


• Education: First Nations run their own schools


• Police and Fire services: First Nations controlled services with community owned equipment


• Health services: Some direct control over health services


• Cultural facilities: including anything from a longhouse to a community centre and the whole variety of public spaces for community activities.

The authors looked at First Nations that had these six factors in place and found something absolutely amazing. Each of these factors provided a significant reduction in the rate of youth suicides. How much? Look at this table:

Now this is impressive. With some self-government in place for example, a community will reduce its youth suicide rate by 85 percent! But the authors discovered something even more amazing. In communities where these six factors are absent, the youth suicide rate is 137.5 per 100,000. That is 800 times the Canadian national average. In communities where all six of these factors are present, the rate drops to 0 per 100,000. You read it right. Zero. Not one suicide in the five year study period. By creating this kind of institutional support in communities, First Nations will literally save their children’s lives.

The authors conclude, rather modestly I think, that “communities that have taken active steps to preserve and rehabilitate their own cultures are shown to be those in which youth suicide rates are dramatically lower.” If these six factors are present, you are much more likely to find yourself in a community where practices of care, sharing, volunteerism, shared leadership, and supportive relationships are present. I’m willing to bet that this fundamental but relatively simple institution building has a multitude of other positive impacts as well. In communities where suicide is a complex epidemic (800 times the national average! That’s a borderline crime against humanity!) having a clear path towards long term community health is a remarkable gift. It means that people can begin to tackle suicide and other mortality measures collectively, with a place for everyone’s responsibility in the long term outcome. We don’t need professionals or experts, all we need is sincere effort, solid citizen engagement and steady progress towards building institutions. The clear implication is that engagement in community and cultural life spills over into relationships and creates the supportive container that gives youth the confidence and sense of belonging and connection they need.

Not to put too fine a point on it, but holding space saves lives. This is toxin handling par excellence.

Amazing.