Nunavut suicide inquest: territorial government defends work on prevention

AGovernment of Nunavut bureaucratdefended the territory's progress on suicide prevention work Thursday at a coroner's inquest in Iqaluitinto the high rate of suicides.

Lynn RyanMacKenzie, the health department's territorial director of mentalhealth andaddictions, was speakingin responseto criticisms lobbed by Nunavut Tunngavik, Inc.and prominent suicide researcher Jack Hicks earlier this week.

"I think one of the challenges of the partnership has been expectations of what that partnership means," MacKenzie testified.

"I can't make commitments on behalf of the government, which seems to be the expectation."

Both Hicks and Natan Obed, who spoke on behalf of NTI, blamed the government's high turnover rate and complex decision-making matrix for slowing progress on the strategy a finding echoed in a recent independentreview.

Since he began work on the strategy in 2007, Obed says as many as 30 people have represented the Government of Nunavut at the table.

Having stepped into her current position abouttwo years ago, MacKenzie says she was "possibly number 30," but argues that the solution suggested by earlier witnesses putting a high-level government employee who can make decisions on behalf of multiple departments at the table is untenable.

"I think it's unrealistic to think one person could be given that responsibility," MacKenzie said.

"That's not how the government is structured."

Strategy 'problematic' from the start

MacKenzie, who was not at the table when the action plan was drafted,testified that it is both "problematic" and "unrealistic."

The objectivesare not clear and that has made it impossible tofulfilgoals, she said.

"It is a credit to the partnership that it has endured a structure of implementation that was problematic," she said, saying their continued workspeaks to the "dedication" and "commitment" of all involved.

MacKenzieproposeda re-imaginedpartnership, based on a successful model used bythe Manitoba government,where the groups are less integrated in their work and instead work toward their goals in parallel.

"Each party could have its own plan and work in collaboration."

Things 'are happening'

In her cross-examination, Kathryn Kellough, the lawyer representing the Akumalik family, who lost 25-year-old Clyde to suicide in 2013, pressed MacKenzie for reasons why goals for improvedtraining andgrief counsellingservices have not been advanced further.

"Is it just too unwieldy?" she asked. "Is it never going to happen?"

"There are things that are happening," MacKenzie answered."We have built capacity. We are building capacity."

The Department of Health representative maintained that the last few years have seen progress in several areas.

"I think one of the problems with this action plan is that somehow it'sconceptualizedthat these are the only things the government is doing."

To bolster that point, the Government of Nunavut entered into evidence a list of 25 active projects related to improving mental health programming, ranging from a mentorship program involving highschool students, to support for the Kamatsiaqtut Helpline,to a tele-psychiatry program in partnership with Toronto's Hospital For Sick Children.

88 workers across Nunavut

Both MacKenzie and Victoria Madsen, the director of mental health for Iqaluit, alsotestified about capacity issues in the mental health system and the challenge of recruiting and retaining staff.

"We need more qualified and experienced counsellors," said Madsen."That is a challenge."

Sheidentifiedtwo other challenges her department is facing: hiring counsellors whospecialize in youth and substance abuse issues andfindingInuktitut-speakingstaff.

Madsenestimates that 75 per cent of Iqaluit positions are filled, but says the services her team provides at theAkausisarvikMental Health Centre and ambulatory clinic are not compromised.

"Sometimes there will be a wait list [at Akausisarvik], but not very long. Never more than two weeks."

MacKenzie testified that as of Sept. 2, 2015,there were 88 frontline staff working in the territory, including 16 inIqaluit.

"Across the board we need more capacity, but there were staff in every community with the exception of Repulse Bay."

Despite thecapacity challenges, Madsen said it's important to continue searching for the most qualified staff, adding that the government has "turned a corner" in its ability to retain staff.

"We owe it to the community that we keep our standards high."

From Jan. 1 to June 30, 2015,Madsenestimates that about 500 people were referred toIqaluit'smental health system, and about 90 per cent of those people became clients.