Thank you so much for the opportunity to speak today. I'll be speaking mainly about the research I've been doing over the past 10 years looking at health inequities among indigenous peoples and at some of the pathways that contribute to the health inequities we see, particularly in relation to mental health.
Some of our research has focused on documenting the health inequities related to mental health. We really don't have a lot of data documenting these inequities across time, and so we don't really know, across different groups, how much worse or better this has become. From the data we have, we see that issues related to psychological distress, suicidal thoughts, and suicidal attempts are getting slightly worse over time and not necessarily getting better.
We compared non-indigenous peoples to first nations on and off reserve, Métis, and Inuit, and we see that first nations living on reserve present more than double the proportion of adults who are reporting suicidal thoughts. The rate is also higher in all of the other indigenous groups. We also note that within these groups, rates of suicide vary significantly across communities and across regions within Canada.
Some of our other research looks at documenting the long-term effects of certain collective traumas faced by indigenous peoples. Much of our work has looked at the long-term effects of Indian residential schools in relation to mental health outcomes.
Here I am showing you a graph representing the proportion of adults who report medium or high levels of psychological distress, based just on a self-reporting questionnaire. This is one of the few questionnaires that measure mental health across these different groups within national surveys that allow us to make some comparisons.
When we looked at this, we found that in the total Canadian population—which actually includes indigenous peoples, so that this number may be elevated a little—about one-third reported moderate or high levels of distress. We compared those findings with results for first nations adults living on reserve according to whether they or their families were affected by the Indian residential school system, and we found that all of those individuals who had a parent or at least one grandparent who attended, or who attended themselves, were at increased risk for psychological distress compared with first nations adults whose families were not affected. This is just to show that the schools affected not only those who attended but also their children and grandchildren.
We looked at that situation across a number of different studies, within both national representative samples and our own data, which we collected on and off reserve. Again we show that those who had at least one parent who went to residential school are at greater risk for reporting high levels of depressive symptoms. In the lower graph on this slide, we show that this was also the case for first nations youth living on reserve.
Already among youth aged 12 to 17 we see that these intergenerational effects of past collective traumas continue to put them at risk for these negative mental health outcomes.
Another goal of our research was to document and explore the pathways that contribute to this increased risk among those whose families have been affected by these major collective traumas. One of the major—and, I think, most intuitive—factors that contribute to this intergenerational trauma is the greater exposure to childhood adversities.
We found that those who had a parent who went to residential school were more likely to report a higher score when we were looking at cumulative exposure to various types of childhood neglect, various types of trauma, and various types of household dysfunction.
The greater risk for childhood adversities in turn put them at risk for experiencing more stress throughout their life. In the literature, this is referred to as a process called “stress proliferation”, where early-life trauma and trauma faced by one's parents continue to put someone at risk for more stress and more trauma throughout their life.
In addition to adult traumas, we found that those affected by residential schools also perceive higher levels of discrimination. Our research in this and other work points to the real negative effects of racism and discrimination on mental health outcomes among indigenous peoples, and not only in general interpersonal day-to-day experiences. There's also a lot of research showing that experiencing racism within the service-provider context in the health care system and within other systems can have even double the negative effects.
Another one of our major findings was that these past collective effects can actually accumulate across generations, so really, if we do nothing to address these intergenerational cycles, we can expect that the effects are only going to get worse.
We did a comparison as shown. These are all first nations adults living on reserve, again from a representative sample, and we compared those whose families had not been affected by residential schools to those who had a parent or a grandparent who attended and to those with a parent and also a grandparent who attended, so two previous generations. We showed that with each additional generation of a family that attended residential school, there was an increased risk of negative mental health outcomes.
We also wanted to see if that effect seemed to transfer to other types of collective trauma. We focused on the residential school system because it was really the only kind of major collectively experienced trauma that we have data on, and we could look at the negative outcomes. The large removal of indigenous children into the foster care systems is another major collectively experienced phenomenon that today contributes to negative outcomes in the same way that the residential school system does.
We showed that the more generations there are in your family that went to residential school, the greater the risk you're at for being removed into foster care at some point in your life. When we looked at the pathways that accounted for these increased risks, we found a kind of sequential relationship, where having a parent who went to residential school put those children at risk of growing up in a household with low economic stability and living in poverty. In turn, that low economic stability put them at risk of just not having a generally stable household. Even if it wasn't about abuse, it was about providing a stable household, which these parents just really couldn't do because of their familial residential school history. In turn, those people were more at risk for being taken into foster care, again really demonstrating the intergenerational nature of all of these environmental and collectively experienced traumas.
Our research looking at this has also found that same effect among youth living on reserve in relation to suicidal ideation and suicidal attempts. What we found is really interesting. When we split the groups up into those aged 12 to 14 and those aged 15 to17, we found that this effect was particularly evident in the younger age group, those aged 12 to 14, which suggests to us the extreme importance of early intervention. When we looked at adults in terms of those who reported suicidal ideation in childhood and youth, it was these individuals who continued to have mental health problems throughout their lives. We know that's also the case in the mainstream population and in the mainstream literature. Those with early onset of any type of mental health disorders are at risk for chronic problems throughout their lives, which really emphasizes the importance of addressing these early on.
In addition to identifying the risk factors that put those affected by residential schools at greater risk, we were also really interested in looking at the protective factors that can protect, because not all of those affected by residential schools do have depressive symptoms or other health problems.
I wanted to share some quotes from subjects in some of our studies in which we have done some qualitative research, just to hear in their own words what has been protective for them. This is from someone whose parent went to residential school.
||I was ashamed growing up but I have since reclaimed my identity.... Now that I am on my own, I have more pride and I am learning to love my identity. I gave my son a traditional Ojibwe name and I vow to raise him to be proud of who he is.
In a lot of our research we constantly heard stories of cultural pride being a really important protective factor. When we looked at that in our quantitative data, we also found that cultural pride was really protective.
In this graph we looked at the negative effects of discrimination in relation to depressive symptoms among first nation adults, and we found a strong relationship. “In-group affect” is just the academic term for cultural pride. When we see those who have high in-group affect, so high pride, we see that those individuals are protected against the negative effects of discrimination. Their depressive symptoms don't shoot up when they perceive these high levels of discrimination. There's other evidence out there showing these protective effects of cultural pride and cultural engagement.
Our research has also really pointed to the importance of learning about historical trauma and learning about residential schools and learning about the foster care system, and how all of these things have affected indigenous peoples. I just want to share another quote on how continued learning about this is needed, because people are still just learning about how this has affected their families.
This person shared the following:
||I found out when I was 27 that my father attended residential school, my sister told me. My father has never spoken to me about it. I read his court statements without his knowledge... and this is where I learnt about the sexual, physical, emotional, and cultural abuse he endured. I was deeply saddened, but it gave me an understanding of why my father behaves the way he does. lt helped me understand the cycle of abuse, because in turn he abused my mother and I. He learnt these behaviours in Residential School and could not cope so he turned to alcohol and so did I... but at the moment I am in treatment and dealing with these issues. I CAN break the cycle.
This is just a quick graph from, again, a representative sample of first nation adults. It points to the importance of traditional healers in dealing with mental health issues. Even though traditional healers are typically not part of the mainstream health system, about one in five adults still reports using traditional healers more often than other types of healers.
This graph shows the number of community projects aimed at healing as a result of the residential school system, and how, as the Aboriginal Healing Foundation was shut down, the availability of these services decreased over time. When we look at that compared to the proportion of adults affected by residential schools on reserve, we see that doesn't match up. We see that the proportion that has been affected themselves, either by attending or by having a parent or grandparent who attended, has not decreased since 2002, and that today our most recent data shows that more than half have been affected intergenerationally by residential schools.
Good afternoon. It's a pleasure to have a chance to meet with you and to be invited to participate in the discussion that has been under way for many years and will continue for some time.
I come to you both as a clinician and as part of now more active health care planning in northwestern Ontario. My clinical work with first nations dates back to the late 1980s and the early 1990s in Labrador, and subsequently as a resident in psychiatry and a researcher in Baffin Island and later Nunavut.
I also now work as a clinician in a collaborative care mental health service model. This is a model of care that I will speak to a little later on in regard to bringing specialty care to primary care locations, which is where much of mental health service gets delivered.
I've been involved with research in the area of indigenous suicide since the early 1990s, and there are a couple of points I want to highlight from both the work I've been involved in and Amy's presentation. These include some challenges to the traditional ideas of suicide and suicidal behaviour in first nation and Inuit communities.
Something that complements what Amy said is that in one study we undertook, we found traditional language maintenance to have a protective effect. There was clearly a difference, as was already pointed out in the data, in that when a community is able to maintain traditional language at a higher rate, there appears to be a lower rate of suicidal ideation and attempts and behaviour.
The other thing that's a bit of a counter to what I'd call a mainstream suicide study is that the presence of common mental disorders explains only a small percentage of variation in suicidal behaviour. In a study I undertook, we looked at two communities in the far north, and we found that although there was a very high incidence of suicidal ideation, less than 20% of it could be explained by the presence of common mental disorders that we were also looking at, such as depression, anxiety, and alcohol abuse.
This is a subtle but important consideration. It means that there are probably other factors in communities that could account for suicidal behaviour. Amy has spoken of this, and I'm sure Dr. Kirmayer will speak of it later. This is important, because when it comes to delivering clinical services, as clinicians we certainly know that mental disorders are a part of the suicide picture, but we have to clearly bear in mind that the social determinants of mental health and the social determinants of health are critical to understanding it. Some of these have been touched on.
I want to emphasize, without getting into the details, the work of Chandler and Lalonde, who published a number of articles on cultural continuity, which has been touched on already. As well, the adverse childhood events study by Felitti is, I think, important. These are highlighted in a number of places and it would be worthwhile for this committee to have as good a grasp of these as possible.
Amy touched on a number of issues, one of which is how generations pass on these effects. I'm not sure, but there may be a few biologists in the room here. The study of epigenetics is increasingly showing that there are biological reasons as to why the trauma that happens to a grandfather or grandparents may be passed on genetically through methylation of the key genetic coding within our own cellular structure.
This is an important phenomenon that is gaining in understanding. It was very gratifying to go to Fort Frances and be asked to talk about passing on trauma, and to then go to a talk, at the American Psychiatric Association meeting, about how the genome project has allowed us to understand many aspects of this. This is important for us to grasp. It's early days, but there is some understanding of what has been touched on. It's very powerful.
I won't touch on the Nunavut suicide strategy or the Pikangikum coroner's report, but I think these are important to have a full grasp of, because the advice is all there, and many of us would be repeating what has come from very bright people preceding us.
In the last few minutes that Andy lets me speak, as a program planner, a chief of psychiatry, and someone who has been involved in the determination of service modelling, I want to touch something on.
I gave a presentation a couple of Fridays ago in Thunder Bay to the Ontario Psychiatric Outreach Program and shared the idea of how we can create specialty service access in places like the Pikangikum nursing station or Pond Inlet. As we evolve the technology of service delivery, I think there are really creative opportunities that are low-intensity and potentially low-cost that we are certainly trying to look at and optimize.
Part of this arises out of the Auditor General's report on nursing stations, which talks about the need for specialist access, not just by having someone fly in but by having someone who can be contacted or having on-site resources that can be developed. I proposed possibilities to increase those, and I'll touch on those in a minute.
The Sachigo Lake study of first aid skills is an example, in our region of northwestern Ontario, of how you can develop a specialized skill in an areas such as crisis assessment and then capacity-build. The issue is how to sustain it, how to deliver it, and how to ensure that the nurse practitioners and RNs in these communities have these skills. I think these are critical.
I have one final point on policy and resources before I move on to a model of care. I sit on the Ontario child and youth mental health funding review committee. I think you folks are placed where this can really have an impact. The social determinants of health are highly impacted by the ability of policy and funding to drive change and create what has been called “equity plus”. That term comes out of a book, and it describes the idea that we are not just looking for fairness or equality but we are looking at, probably for some time, an enhanced funding formula that will need to give consideration to distribution of resources. I really think the social determinants of health highlight the importance. It's not just about health care delivery; it's about improving job opportunities and addressing poverty and housing.
I'll close with a couple of comments and highlight a few key things. I've had the opportunity to try to steal from across the country and from outside of the country some of the best service-delivery models. The conceptual draft model I am now entertaining with our local health integration network includes a few conceptual ideas that build upon a stable primary care system. Any discussion about enhancing health care has to be built on a stable primary care system, whether that's family doctors, nurse practitioners, or good nurses with solid skills.
In primary care, I think we are underperforming in a lot of avenues: in the development of a basic understanding of crisis assessment, in the skills to deal with suicidal ideation and in the skills to deal with basic depression and anxiety. Things like the CBIS model, which is a cognitive behavioural therapy model out of British Columbia, and DBT, which is an enhanced cognitive behavioural therapy model, deserve some community and cultural adaptation. I have had discussions with Dr. Mushquash in Thunder Bay about this, and maybe you've heard about it as well.
The RACE model in British Columbia—rapid access to consultative expertise—offers a model of care across a number of specialties. Someone calls and says, “I need to talk to someone who is a primary care provider in two hours to two days. Who do I call, and how do I do that?” It's possible. It has worked in British Columbia.
With regard to access, we are moving into the health care system delivery model. It started out of a cardiology and a family practice unit in Vancouver that said, “Why can I live next door to specialists who are 200 feet away and I can't call anybody?” It's something that is translatable anywhere in Canada, no matter how rural and remote.
The Ottawa e-consultation model is another model that says, if a family doctor or nurse practitioner doesn't need to speak to someone in two hours to two days but could do so maybe in the next three to seven days. It is looking at province-wide implementation in Ontario, and I think it should be given some consideration. It has been strongly piloted, with somewhere around 6,000 consultations in the four years it's been running in Ottawa. It is being piloted in our area of northwestern Ontario, and I look forward to seeing that happen.
As a primary care provider, if I don't need to speak to a specialist, how can I get assistance for someone with common mental disorders such as depression and anxiety that is adaptable to settings such as nursing stations. The case consultation or the ECHO mental health model, which is coming out of the Centre for Addiction and Mental Health, is an additional model.
What you are hearing me describe is a progressive pyramid of innovations that add to what exists currently, which is, for someone who is in a crisis and needs to be in a crisis bed at a hospital, either a “Form 1” or an elective consultation.
We don't seem to have a lot in between. We have an adaptation of e-consultations, rapid assessment, and the ECHO mental health program, which is an intensive mental health training program that is available for any primary care provider. Last, there is case consultation, which we've integrated across a number of NP clinics that I've been working with. I'd be glad to further discuss this model of psychiatric access, which I'd like to see implemented, that optimizes a lot of service-delivery innovations.
The last thing I want to talk about is PCVC. Anyone with a computer, as long as it has a little camera on it, can link up anywhere in the country that has WiFi to access a specialist on an encrypted network. I think this allows turning down some of the steam on a nurse practitioner sitting in an outlying community that has no road access, who can say I'm not sure how to manage this but I can put the patient in front of you if you'd like to help. We have a chance of having that with the available technologies, which are an enhancement of the telepsychiatry model that currently exists.
I'll pause there. Sorry for going over.
Here's the thing. We had a horrific suicide crisis in Attawapiskat in March or April. At the same time there were six states of emergency declared across Canada in communities that were completely overwhelmed and could not deal with the self-destructive behaviour of their youth. Yet every time it happens, it seems to me that at the government level there's shock; there's surprise. They tweet out that it's a tragedy.
To me, a tragedy is someone getting hit by a car while they're walking home. Something that's predictable, something that's preventable is not a tragedy to me. That's something else; it's a form of negligence.
I mention that because I was in Saskatchewan talking to people about the latest suicide crisis, and we were getting the same level of response—the shock, the surprise. Now we're going to send in an emergency team and we might have them for 30 days.
I was talking to front-line workers who had been doing the programming of suicide prevention. They are not working up in La Ronge because their funding is gone. They get hired on these short-term projects.
I look at the projects funded by the Aboriginal Healing Foundation, and I see the dramatic drop-off from 2009 down to 2012. From that point on, in my region we had 700-plus suicide attempts, and nothing was done.
I'd like to ask you about this idea of sending in an emergency team. The minister, God love her, sent out a tweet the other night, saying, “Hey kids, there's a 24-hour hotline,” as opposed to supporting the people who could actually do the preventative work.
Do you see that there's a connection between these suicide clusters and suicide effects, and the fact that there is no proactive programming in many of the high-risk regions where we could have predicted this would happen?
I can add to that, Mr. McLeod.
I'd like to point out two things. The Anishnawbe Mushkiki clinic was a place where people felt invited because of their cultural identification. And it's usually the opposite: “Don't bother coming here if you smell or if your clothes are old”, and so people don't feel welcome. This is actually just down the road from where I work, and where Don's office is, and I think it really creates an environment that says, “We're here to engage with you, and your cultural identity matters.”
The other place is in Fort Frances, at the tribal councillors' group where I visit. They had to overcome things like wanting to have a sweat lodge in their backyard, being able to do smudging and other traditional things, and they said, “We're asserting ourselves here. We're in the town but we're also doing traditional practices”, and I really felt that, again, it was an invitation to say, “If that's what you'd like to engage with, we're running it every week. This is when we do these ceremonies.”
I think it has been a really important part for the individuals who access it, who are interested in traditions. It's important for those of us with non-traditional interests as well. We need to learn that. I'm thinking of the residents, medical students, and trainees in social work. This really matters. If we don't start having these things as visible and really existing..., then we won't be able to even understand what these mean. They'll all end up being just a museum experience. I felt Fort Frances was exemplary. There's a sweat lodge on CAMH's campus, at the medical school in Thunder Bay, and in Sudbury, I believe. I think we're starting to change and to be more welcoming of those.
Thank you very much, Mr. Chair.
It's a privilege for me to be able to speak with you. I regret I can't be there in person, and I thank you for your patience with telecommunications. I had the opportunity to listen to the last 20 or 25 minutes or so of my colleagues' presentation, so I'll try to build a little on that in my own remarks.
With regard to my own background and the perspective that I bring to this, the program I direct at McGill is focused on issues of culture and mental health. It's primarily concerned with putting the social and cultural dimensions into our thinking about mental health problems. I also direct the national Network for Aboriginal Mental Health Research, which was funded by CIHR to build capacity across Canada to do research in ways that respond to the needs of communities, in terms of both the protocols and the actual topics of concern.
My own research was driven by my experience as a clinician working in northern Quebec and Nunavut, going back to the late eighties, during which time I encountered many young people making suicide attempts. Despite efforts on the part of myself and many people in the communities, over time the problem has continued in many places, and indeed has been exacerbated by a variety of factors.
My own research over 25 years or so now, with many colleagues, has been aimed at trying to understand what is distinctive about indigenous mental health issues, and suicide in particular, with a view to developing meaningful interventions.
I'll say a few words about what's distinctive. I apologize, again. I know this presentation is coming at the end of a long string of experts you have heard, who have given you, I hope, a very vivid picture. Most of what I'm going to say, I'm sure is already very familiar to you. Hopefully, I can address specific issues with you in the questions afterward.
What's distinctive about the situation of indigenous people in Canada is, first of all, the shared history of colonization and of the state apparatus that specifically targeted people's cultures and ways of life, and, in so doing, unravelled some of the fabric of community for people in ways that are still echoing down the generations.
What's also a common dilemma across these communities is their very geographic locations, their cultures and contexts, which pose challenges for the delivery of conventional mental health services. Finally, what's distinctive, looking more specifically at mental health, is the fact that suicide in these communities occurs primarily among young people, starting from early teens into young adulthood, and it often occurs in clusters. I think all of these are reflections of a particular social dynamic, a particular social context.
In addition to the conventional psychiatric or psychological or mental health approach, which tends to focus on individual characteristics and individual vulnerability, all of that kind of knowledge is certainly pertinent to understanding why one person rather than another in any particular community is vulnerable. However, given the high levels across whole communities and whole cohorts of young people, we have to look at the broader factors. Those are primarily social and structural factors. They include what I've already mentioned and what the work of many speakers, including Amy Bombay, speaks to, which is this history of suppression of culture and of forced assimilation and the disruption to parenting that resulted, in terms of the kinds of early parenting experiences that young people have in the community.
Then, in addition to those transgenerational forces, there are ongoing structural problems related to poverty, to relative poverty, not just to the absolute constraints of infrastructure, but to young people's sense of their own possibilities or disadvantage. There are also the problems of housing and crowding, infrastructure, and limited educational and vocational opportunities. Added to that mix is exposure to high rates of interpersonal violence, childhood abuse, and domestic abuse, resulting from trauma-related problems.
Finally, in the larger society, there is a dilemma of what we could call the “misrecognition” of indigenous people in terms of their histories, their autonomy, and their identities, and, along with that in many places, elements of racism and discrimination that really hit people very hard.
All of these issues need to be looked at to try to explain why certain communities, many indigenous communities, and young people in particular are affected. Also, in a sense, we have to put together the conventional body of knowledge in mental health around individual vulnerability, which most of our interventions are oriented toward, with a broader social perspective that understands these historical and contemporary forces that are really raising the vulnerability of a whole population.
We've also been involved in research, working with different first nations and Inuit communities around questions of resilience, because although rates of suicide are high in many communities, of course there are many communities and many families and individuals who are doing well, despite common adversities. There again, we assume that much of what's been learned about resilience in the general psychological literature is pertinent, but in our research, we try to look at what might be specific to indigenous communities in terms of aspects of resilience.
Very roughly, four broad themes came out of that work.
One was the notion of identity as being tied to place, tied to the land, and tied to the environment, and the sense in which one can have a self that is deeply related to the environment. That applies in particular for communities in remote and rural areas, where people are still very much surrounded by a living environment that they feel emotionally connected to.
The second distinctive source of resilience—I mention these because if we are looking at vulnerability factors, we also have to look at where the solutions might lie—has to with the recuperation of tradition, language, and spirituality, all of those sources of positive identity that we each draw from to have a sense of who we are and where we come from and a sense of pride in our background. Since that was an explicit target of the state policies that I've mentioned, such as residential schools and other policies, the strengthening and reinvigoration of indigenous traditions is recognized as important in many communities.
The third has to do with the oral transmission of knowledge, the idea that one trusted source of knowledge—the most basic, perhaps—comes from other people, and it comes in the form of stories that are rooted in tradition and convey a sense of collective knowledge that can then be a source of personal strength and problem-solving ability.
Finally, the thing that was raised by a number of communities we worked with was the notion of political activism. Given the history of disempowerment and the conflicts people have faced, the ability to engage actively in some way in taking control of local institutions—as was shown in the work of Michael Chandler and Chris Lalonde—and being able to feel a sense of empowerment and a collective voice is a very important issue, and for young people as well.
We've been interested in how these kinds of observations, which come from communities themselves, can be translated into effective intervention. Part of the challenge is that suicide itself, although it's an urgent problem and demands its own focus, is in a sense part of a larger array of interwoven issues related to mental health and well-being, so it probably requires a multipronged approach, in which some responses are targeted to the acute vulnerability to suicide, and others have to do with following up on people who are recognized as being at risk and providing them with appropriate resources that can prevent the escalation of their problem. Ultimately, they would have to do with long-term prevention, beginning with very young children and with parents before they have children, working through infancy and early childhood, and helping to strengthen resilience.
I mentioned a multipronged approach partly representing different time frames. When individuals are in acute crisis, they need support and intervention at that time, and that requires particular resources. That raises right away one of the dilemmas in small remote communities, which is that our models of crisis intervention, for example, are generally based on a large urban environment where helping professionals are not directly related to the people who are involved. That's how people are trained, and that's how the various kinds of interventions are configured. It's very different in small communities, where it's likely that somebody who is affected is closely related to the people who are ostensibly offering help. That has both strengths and limitations. The strength is obviously that there is, or can be, a strong emotional bond and a deep understanding of the individual's predicament. The limitation is that it can be overwhelming for the care providers. They may feel that their actions are very constrained because of their relations with other people, and so on. It's part of why I say I think it's important to have both inside sources of help and support from outside, when a community is facing particularly challenging and severe acute problems.
There's no substitute for local support, for a safe place to go, for somebody who can be with individuals who are in crisis and who can offer a kind of warmth of human connection and understanding of their predicament, and solidarity, and intervene to protect them in different ways.
But there's also a need for people who have an ability to stand back from the situation and offer help and support from a position of not being entangled in whatever local conflicts are at that moment affecting the young person, for example.
This is one central issue in terms of training community mental health workers in crisis intervention, whether it's coming through the nursing station, a community worker, a self-help organization, a church, or other organizations within communities. It's one dilemma, and I think here again is an example of how it would be important to use perhaps e-health and other strategies to support people from a distance to do the work that only they can do up close because of their intimate knowledge.
This speaks to an equally important issue in terms of the intermediate range of intervention. When we think of intermediate intervention in this context, we're talking about identifying people—youth in particular—who may be at high risk for repeated suicide attempts or ultimately for death by suicide. They may need more intensive intervention, something along the lines of an extensive re-engagement, with connection in social networks, with some form of focused cognitive therapy, dialectical behaviour therapy, particular forms of intervention that help people who are having lots of recurrent and intense suicidal feelings and ideation, to help them deal with it more effectively. That is a fairly skilled kind of intervention, which again probably needs to be provided through some kind of pairing of local people and someone available perhaps outside the community.
Finally on the largest scale and the longest time frame, the hope is that we can really prevent more people from getting into the kind of predicament of contemplating suicide, and that is through prevention programs. Those I think are very clearly things that can be provided primarily by the community with help from outside the community in terms of programming.
I want to thank Dr. Kirmayer for his excellent presentation. There's certainly much I'd love to discuss with him.
My colleague has brought forward the issue of the motion on truth and reconciliation. It is very pertinent because of the issue of the youth; what is going to be done with the youth today was one of the key findings, in the truth and reconciliation calls to action. We had a promise from the Prime Minister to bring forward every recommendation, and to implement it. I was there when the Prime Minister gave his word to the survivors that this would be done. This is a promise that runs bigger than an election promise. This is about a solemn promise that's made by a nation, through its parliament, through its Prime Minister.
I have to say on the record that of all the days I was in Parliament, I was proudest on the day the previous Prime Minister made that historic apology. That was a moment when Canada said we would make this right, and we still haven't made it right. We've seen this past week that the incredible work of Gord Downie and the Wenjack family has touched Canadians. We, as a nation, want reconciliation. We're expecting our officials to move on reconciliation. We expect this Prime Minister to follow through. I believe this is a recommendation to study this. This is not a partisan issue. This is about how we, through the Parliament of Canada, follow through on the promise that was made, that the Prime Minister speaking on behalf of all us and all Canadians, made.
If we are not going to look at the issue of truth and reconciliation and implementation of it, that would send me a very clear signal that this was just another promise to be broken, just another ploy. That would send a very negative message. We have to make sure that this nation-to-nation relationship is one of respect. It is perfectly reasonable for our committee to study it. Where else would we study it if not at our committee? We can be asking the ministers where they're going. This is not a confrontation. We are all in this as the Parliament of Canada, as the people of Canada. We want to know that path forward.
I thank my honourable colleague for his leadership on this and for bringing this forward. I certainly think that a vote is very important on this.
Thank you, Mr. Chair and members of the committee. This is no longer my permanent assignment, but I spent more than two years as the parliamentary secretary on this committee. I know the good work and the general collegiality that existed then and that I've heard exists here now.
I too, like Charlie, remember the Liberal Party of Canada quite quickly—before the full report was even released—saying that they accepted all of the recommendations without fail, every single one of them, and that they would implement them. That was part of their solemn promise to indigenous Canadians and to all Canadians.
I think quite frankly that having Mr. Yurdiga bring this forward is a step forward. You're talking today about suicide among indigenous peoples and communities. We can trace much of the current state of affairs, particularly on reserve, back to the dark chapter of Canadian history that involves the residential schools. This is a multi-generational issue that continues to manifest itself today.
I would say that, rather than this being an insult to the professor, this is actually extremely important and extremely germane to the study we are embarking on today, because this is a promise that was made.
It has been now nearly two years. We need to have a progress update. We need to have measurables. We need to move past words to action. All of the good words, and they are good words, about making things better for indigenous communities are only that, if they're not followed up on with significant action.
That's where we want to focus as Conservative members on this committee. As members of the official opposition, we want a report. It's just to get that update.
Concerning the fact that there's committee business, what the public or the witness might not know is that it occurs in an in camera discussion; it's not in public. If this motion is moved in private and it doesn't come out the other end, well, Canadians will know what happened to this motion, I think, seeing the unanimous support for the motion on this side of the table.
We want this to be debated in public. We want it to be debated, because we think it's the right thing to do, to get that progress update and see it done in a respectful way. There's no torqued-up language in this; no one's looking to embarrass anyone. We just want to get tangible, meaningful discussions to take place, we want to have those discussions in public, and we want this vote to take place in public, which is why Mr. Yurdiga moved it now. I salute him for it and I'll be supporting it.