GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES - Centre of Best Practice ...

 
GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES - Centre of Best Practice ...
GLOBAL OVERVIEW:
INDIGENOUS SUICIDE RATES
GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES - Centre of Best Practice ...
GLOBAL OVERVIEW:
INDIGENOUS SUICIDE RATES

         Professor Pat Dudgeon, Dr Ian Ring,
    Georgia Leyendekkers, Dr Kahu McClintock,
      Dr Keri Lawson-Te Aho, Dr Malcolm King,
   Dr Alexandra King, Dr Gayle Skawen:nio Morse,
       Michele Connolly and Jon Petter A Stoor

                        The Centre of Best Practice in
                         Aboriginal and Torres Strait
                         Islander Suicide Prevention

                                          GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 1
 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
The Centre of Best Practice in
                           Aboriginal and Torres Strait                                                        Poche Centre for
                           Islander Suicide Prevention                                                         Indigenous Health

     Cover Artwork Shifting Sands by Roma Winmar

     Authors
            Professor Pat Dudgeon Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention,
            Poche Centre for Indigenous Health, University of Western Australia.
            Dr Ian Ring Adjunct Professor, University of Wollongong, Australia.
            Georgia Leyendekkers Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention,
            Poche Centre for Indigenous Health, University of Western Australia.
            Dr Kahu McClintock Te Kìwai Rangahau, Te Rau Matatini (National Centre for Māori Health,
            Māori Workforce Development and Excellence). Aotearoa/New Zealand.
            Dr Keri Lawson-Te Aho Department of Public Health, University of Otago, Aotearoa/New Zealand.
            Dr Malcolm King Professor, Department of Community Health and Epidemiology,
            University of Saskatchewan, Canada.
            Dr Alexandra King Inaugural Cameco Chair in Indigenous Health and Wellness,
            University of Saskatchewan, Canada.
            Dr Gayle Skawen:nio Morse School of Health Sciences, The Sage Colleges,
            United States of America.
            Michele Connolly International Group on Indigenous Health Measurement, United States of America.
            Jon Petter A Stoor Sámi Norwegian National Advisory Unit on Mental Health and Substance Use (SANKS),
            Finnmark County Hospital Trust, Norway.

     The Centre of Best Practice in Aboriginal and Torres Strait Islander Suicide Prevention is funded by the Australian
     Government through the Department of Health’s National Suicide Prevention Leadership and Support Program.

     This material is copyright © University of Western Australia, except where otherwise indicated. You may download, store
     in cache, display, print and reproduce the material in an unaltered form only (retaining this notice, or links to it where they
     appear) for your personal, non-commercial use or use within your organisation. You may not deal with the material in a
     manner that might mislead or deceive any person.

     Poche Centre for Indigenous Health
     School of Indigenous Studies
     University of Western Australia
     08 6488 3428 35
     Stirling Highway, Crawley, Western Australia 6009

     Published: November 2018

     Publications (online) ISBN: 978-1-74052-408-7

     Reference: Dudgeon et al. (2018). Global Overview: Indigenous Suicide Rates. Perth, WA: University of Western Australia.

     The opinions, comments and analyses expressed in the document are those of the author/s and individual participants
     and do not necessarily represent the views of the Government and cannot be taken in any way as expressions of
     Government Policy.

2|   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
     CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
TA B L E O F C O N T E N T S

GLOSSARY.......................................................................................... 4

INTRODUCTION............................................................................... 5

DEFINITIONS OF INDIGENOUS PEOPLES................................ 6

COLONISATION AND SUICIDE.................................................... 6
      Notes...........................................................................................................6
CAPTURING WORLD INDIGENOUS SUICIDE RATES.............. 7

OVERVIEW BY COUNTRY.............................................................. 8
      Australia .....................................................................................................8
      Aotearoa: New Zealand ..........................................................................10
TURTLE ISLAND: NORTH AMERICAN CONTINENT...............12
      Canada ..................................................................................................... 12
      United States of America ...................................................................... 16
CIRCUMPOLAR REGIONS............................................................19
      Sápmi: Scandinavia.................................................................................. 19
      Kalaallit Nunaat: Greenland.................................................................... 21
APPENDICES................................................................................... 22
       ppendix 1: Table: Suicide Data for Overall Populations at Latest
      A
      Available Year.......................................................................................... 22
REFERENCES.................................................................................. 23

                                                          GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 3
                 CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
GLOSSARY

     Mainstream: Usually the non-Indigenous population of the country, alternatively- the dominant population.

     Dominant society: Usually the White dominant population and systems of government of a Western country.
     This population usually has a higher population than the Indigenous population.

     Overall: Overall data includes total population of the country- including Indigenous and non-Indigenous peoples.

     Indigenous peoples1: The working definition used throughout this paper is as below. For a more detailed understanding
     of Indigenous peoples, see A working definition, by José Martinez Cobo (IWGIA, 2011).

     Colonisation: The process of settling and establishing control over the Indigenous peoples of an area2.

     Age-standardised: The age-standardised mortality rate is a weighted average of the age-specific mortality rates per
     100,000 persons, where the weights are the proportions of persons in the corresponding age groups of the corresponding
     countries standard population.

     1    The terms used for First Nations or Indigenous peoples, like 'Australian Aboriginal peoples', 'Inuit’ and 'Indigenous' are used interchangeably. It is
          acknowledged that there are many cultural differences amongst and within the world’s First Nations and Indigenous communities and the use of differing
          terms does not intend to disregard such differences. For the purpose of this report, the term ‘Indigenous’ is used, unless specific groups of Indigenous
          people need to be recognised.
     2    This definition is commonly used; however, some Indigenous peoples use the term ‘invasion’ to describe the process of colonisation.

4|   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
     CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
INTRODUCTION

This background paper presents an overview of suicide in Indigenous peoples in countries where there is a dominant
White society. The countries identified for this background paper share similar colonial histories and all but Greenland have
populations where the Indigenous population is significantly smaller in comparison to the non-Indigenous/mainstream
population.

The countries reviewed for suicide rates were Australia, Aotearoa/New Zealand, Canada, the United States of America,
Greenland, and Scandinavian countries of Finland, Norway, Sweden, and Russia3. These are all countries where the
Indigenous peoples have elevated suicide rates compared to the non-Indigenous/mainstream population (Pollock, Naicker,
Loro, Mulay & Colman, 2018).

Whilst definite figures for Greenland are unavailable, a rate of 82.8 suicide deaths per 100 000 in 2015 was identified in an
analysis of suicides (Hersher, 2016). Greenland Inuit people make up 90% of the population of Greenland, and it shares a
colonial history. A global comparison of Indigenous suicide rates to non-Indigenous rates at particular time periods in these
colonised countries has been collected in the following table.

                                                                                     Global Comparisons:
                                                            Indigenous and Non-Indigenous Population Suicide Rates at Various Years
                                                       80                                                              76.9
         Number of Suicide deaths per 100 000 People

                                                       70

                                                       60

                                                       50

                                                       40
                                                                                                  31.8
                                                       30   25.5
                                                                                                                                        21.4
                                                                                18.4
                                                       20                                                                                      13.5
                                                                   12.6                 11.1                                    11.2
                                                                                                            10.8
                                                       10

                                                        0
                                                             Australia           Aotearoa/NZ          Canada              Canada        USA (2016)
                                                              (2016)                (2013)        (First Nations,      (Inuit Region
                                                                                                   1993-2009)          v Overall Pop,
                                                                                                                        2004-2008)

                                                                   Overall Population          Indigenous Population

Table 1: Global Comparisons: Indigenous and Non-Indigenous Population Suicide Rates at Various Years. Australia (Australian Bureau of
Statistics, 2018), Aotearoa/NZ (Ministry of Health - Manatū Hauora, 2017) Canada (Statistics Canada, 2018a; Pollock, Mulay, Valcour &
Jong, 2016), USA (American Foundation of Suicide Prevention, 2016; Jiaquan et al., 2018).

For comparisons of overall population data4 on suicide deaths in these countries, the figures on suicide deaths, age-
standardised at the latest available year are available in Appendix 1.

3     These are the four countries in which the Indigenous Sámi peoples live, with the Sámi lands referred to as Sápmi.
4     Overall data includes total population of the country- including Indigenous and non-Indigenous peoples.

                                                                                                                  GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 5
                                                                         CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
DEFINITIONS OF INDIGENOUS PEOPLES

     This paper uses the widely accepted working definition developed by the United Nations;

            Indigenous communities, peoples and nations are those which, having a historical continuity with pre-invasion and
            pre-colonial societies that developed on their territories, consider themselves distinct from other sectors of the
            societies now prevailing in those territories, or parts of them. They form at present non-dominant sectors of society
            and are determined to preserve, develop and transmit to future generations their ancestral territories, and their ethnic
            identity, as the basis of their continued existence as peoples, in accordance with their own cultural patterns, social
            institutions and legal systems. (IWGIA, 2018)

                                          COLONISATION AND SUICIDE

     Countries in which Indigenous people remain a dispossessed minority face considerable adversity, part of which includes the
     impacts of the history of colonisation. As Indigenous populations engage in processes of recovery and cultural reclamation,
     the processes of colonisation have left a legacy showing up as disadvantage, particularly in comparison to mainstream
     populations. These issues are shared by Indigenous populations across the globe. In particular, high rates of suicide are a
     shared issue. As colonisation is a social determinant of suicide (Redvers et al., 2015), Indigenous peoples in nations with
     shared colonial histories are highlighted in this paper.

     Suicide is complex and should be treated as such, including the ways in which the complex traumas of colonisation can
     contribute to suicide deaths in Indigenous communities living in colonised countries. By culturally contextualising suicide
     deaths for Indigenous people, this paper aims to collaborate information in these countries to better inform and strengthen
     suicide prevention.

     It also needs to be noted that behind each number is a person, a family, and a community grieving the impacts of suicide.

     Notes
     There is a lack of global comparative data for Indigenous and non-Indigenous populations across different countries. The
     in-country data used in this paper may not use methodologies consistent to the comparable countries. However, data
     sources are referenced throughout this paper and need to be considered when interpreting the findings. Not all in-country
     demographic data, including systematic health data collection systems for specific groups, is readily available.

     Where age-standardised and gender-standardised data is available, it is made clear throughout the paper. However,
     variations in Indigenous grouping (eg. distinctions made between Métis peoples and Inuit peoples in Canada), and regional
     variations (eg. Remote circumpolar and urban regions) were not always distinct.

6|   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
     CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
CAPTURING WORLD INDIGENOUS SUICIDE RATES

                                                                                  Sápmi:
           Canada:                                                         Sámi peoples suicide
    First Nations peoples                                                  rates are elevated in
      have suicide rates                                                  comparison to majority
    nearly three times the                                                populations in Norway,
       national average                                                        Sweden and
                                                                                 Finland.

                                           G R E E N L AN D

                   C A N AD A

                                                 Circumpolar
                                                    Regions:
                  U N ITED STAT E S           Inuit communities in                                                           Aotearoa/New
                    OF AM ERIC A            Canada and Greenland                                                                Zealand:
                                            experience some of the                                                        Māori suicide rates are
                                             highest suicide rates                                                         over one and a half
                                                  in the world.                                                             times the general
                                                                                                                                population

         USA:
 American Indian and
 Alaska Native suicide                                                                                 A US T R A L I A
rates are over one and
    a half times the
   national average.                                                             Australia:
                                                                           Aboriginal and Torres
                                                                           Strait Islander people
                                                                          suicide rates are twice
                                                                                 the general
                                                                                 population.

     Map 1: Indigenous Suicide Rates, Global Context.

                                                                                GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 7
                                       CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
OVERVIEW BY COUNTRY

           BRIEF TIMELINE
                                                                                                     AUSTRALIA
      Approximately 500-700 groups,
      languages, and/or tribes and
      750 000 at time of colonisation                                                                Overview
                                                                                                     Australia’s population is currently estimated to be just over 25 million people,
      Aboriginal and Torres Strait
                                                                                                     with an estimated almost 800 000 people identifying as Aboriginal, Torres
      Islander peoples living in Australia
                                                                                                     Strait Islander, or both Aboriginal and Torres Strait Islander (Australian Bureau
      between 40-60,000 years ago.
                                                                                                     Statistics, 2018c).
      1788: Beginning of colonisation
                                                                                                     A brief timeline of Australia’s history shows that in the years since European
      as European settlers/invaders
                                                                                                     settlers arrived, colonisation has had a profound impact on Aboriginal and
      arrived.
                                                                                                     Torres Strait Islander peoples, health, land, and cultures. In 2018, Aboriginal
      Frontiers wars, land and resource                                                              and Torres Strait Islander communities face some of the highest suicide rates in
      disputes, slave labour, and                                                                    the world, and it is the fifth leading cause of death compared to 13th for non-
      violence followed.                                                                             Indigenous Australians (ABS, 2018b).

      1900s: Laws of assimilation and                                                                According to the latest figures provided by the Australian Bureau of Statistics
      denial made and implemented                                                                    (ABS), Indigenous Australian suicide rates were double the overall Australian
      about Aboriginal cultures,                                                                     rate in 2017 (ABS, 2018a; ABS, 2018b).
      languages and history. The forced
                                                                                                     Suicide accounts for a greater proportion of overall deaths amongst Aboriginal
      removal of Indigenous children.
                                                                                                     and Torres Strait Islander peoples than non-Indigenous Australians, at 5.5%
      Health issues and mental health                                                                compared to 2.0% in 2017 (ABS, 2018c).
      issues pertinent in Aboriginal and
                                                                                                                              Australia: 2017 Suicide Rates
      Torres Strait Islander communities
      as a result of colonisation.                                                                   45
                                                                                                             39.6
                                                       Number of Suicide deaths per 100 000 People

                                                                                                     40
      High rates of suicide and
      other health issues. Still no                                                                  35
      treaty between the Australian
                                                                                                     30
      governments and the traditional                                                                                       25.5
      custodians of the land.                                                                        25
                                                                                                                                     19.7                      19.1
      Contemporary: Aboriginal and                                                                   20
      Torres Strait Islander population                                                              15             11.9                           12.7                         21.6
      around 3% of 25 million
      Australians 120 Indigenous                                                                     10
                                                                                                                                             6.0                       6.2
      language groups remain in                                                                       5
      2018 with many at high risk, but
      language and cultural reclamation                                                               0
                                                                                                                Indigenous            Non-Indigenous                  Overall
      is strong.

      (Mooney, 2018; Australia Institute of
      Aboriginal and Torres Strait Islander Studies,                                                                Males          Females             Total
      2018)

                                                                                                     Table 2: Australia: 2017 Suicide Rates. Data retrieved from the Australian Bureau of
                                                                                                     Statistics (ABS, 2018a; ABS, 2018b). There is no disaggregated data between Aboriginal
                                                                                                     and Torres Strait Islander groups.

8|   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
     CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
Aboriginal and Torres Strait Islander Youth
In 2017, suicide remained the leading cause of death for both Aboriginal and Torres Strait Islander and
non-Indigenous children and young people between 5-17 years of age. Suicide accounted for 40% of all
Indigenous deaths in this age bracket.

For 2013 – 2017, Aboriginal and Torres Strait Islander youth (aged 5-17 years of age) accounted for
26.7% of Indigenous deaths by suicide, with suicide rates for Aboriginal and Torres Strait Islander children
and young people at 10.1 suicide deaths per 100 000 persons, compared to the same age group of
non-Indigenous people at 2 suicide deaths per 100 000 peoples (ABS, 2018c).

Young Indigenous men are at the highest risk of suicide (The Department of Health, 2013). In the 2013
National Aboriginal and Torres Strait Islander Suicide Prevention Strategy, it was indicated that the highest
age-specific rate of Aboriginal and Torres Strait Islander suicide was among males between 25 and 29
years of age at 90.8 suicide deaths per 100,000 persons, four times the rate for non-Indigenous males
(2013).

Regional Disparity
Suicide rates vary geographically and
within groups such as youth. In the
Kimberley region of Western Australia in           TIMOR SEA                                                          PACIFIC OCEAN
the 10 year period between 2005-2014                                   KIMBERLEY
                                                                        REGION
there was an age-adjusted rate of 74                                                  NORTHERN
suicide deaths per 100 000 peoples                                                    TERRITORY

(McHugh, Campbell, Chapman &
Balaratnasingam, 2016).                                                                                 QUEENSLAND
                                                               WESTERN
                                                               AUSTRALIA
Risk Factors
                                                                                           SOUTH
The high Indigenous suicide rate in
                                                                                         AUSTRALIA
Australia is attributed to a range of
complex and interrelated factors that
heighten the risk for suicidal behaviours.                                                                   NEW SOUTH
These include trauma, grief and loss                                                                           WALES
associated with the ongoing impacts                                                                                  Canberra
                                                                              INDIAN OCEAN
of colonisation and dislocation. Such                                                                     VICTORIA
impacts include the effects of forced
removal of children, mistreatment and
                                                    Map 2: Map of Australia, Kimberley Region.
pervasive racism and discrimination at
                                                                                                            TASMANIA
the individual, institutional and system
levels, and the cumulative impacts of
ongoing exposure to socio-economic disadvantage and various other psychological stressors (Dudgeon et
al., 2016). Loss of language, culture, and land struggles have been attributed to elevated suicide rates.

                                                                         GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 9
                                CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
BRIEF TIMELINE                                                                              AOTEAROA: NEW ZEALAND
           The Māori population around
           1800 was approximately                                                                           Overview
           100-120 000 people                                                                               New Zealand, or known in the Māori language as Aotearoa, has an estimated
                                                                                                            population of 4.5 million with Māori people representing 15% (IWGIA, 2018).
           Māori are the Indigenous peoples
                                                                                                            The Indigenous Polynesian Māori peoples had occupied Aotearoa for more
           of New Zealand, or known to the
                                                                                                            than 700 years before European arrival between 1769-79.
           Māori as Aotearoa.

           Late 1700s: Colonisation began                                                                                  Aotearoa/New Zealand: 2015 Suicide Rates
           and land wars followed between
                                                                                                            30
           Māori people and the new settler
                                                              Number of Suicide deaths per 100 000 People          25.3
           population.
                                                                                                            25
           Treaty of Waitangi signed in 1840
           but not implemented.                                                                             20                    18.4
                                                                                                                                                                          16.4
           Due to the hostile takeover of                                                                                                 14.7
                                                                                                            15
           lands and the introduction of
                                                                                                                          11.5                                                             11.1
           diseases by Europeans, the Māori                                                                                                                 9.7
           population had declined by the                                                                   10
           end of the 1800s.                                                                                                                                                      6.1
                                                                                                                                                   4.7
                                                                                                             5
           The Māori population face
           adversity across all social and
                                                                                                             0
           health indicators, including higher                                                                            Māori               Non-Māori                          Overall
           suicide rates at nearly twice the
           general population.
                                                                                                                          Males          Females                  Total
           Contemporary: Māori population
           is 15% of overall New Zealand
           population. First World Indigenous                                                               Table 3: Aotearoa/New Zealand: 2015 Suicide           PACIFIC OCEAN
                                                                                                            Rates. Overall data, and sex-specific data for Māori
           Suicide Prevention conference
                                                                                                            and non-Māori figures was retrieved from Ministry of
           held in Aotearoa in 2016,                                                                        Health - Manatū Hauora (2017). Total data for Māori and
           presenting the Turamarama                                                                        non-Māori figures were mean-valued, as they
           Declaration for Suicide Prevention.                                                              were not available from data sources                                                           NORTH
           (Ministry for Culture and Heritage, 2018)                                                                                                                                                       ISLAND
                                                                                                            Māori Peoples                                                         Auckland
                                                        Data indicates that Māori peoples       TASMAN SEA
       are at higher risk of suicide than non-Māori peoples. Māori males accounted for
       25.3 and Māori females 11.5 suicide deaths per 100 000 in 2015. This is compared
       to non-Māori males at 14.7 and non-Māori females 4.7 suicide deaths per 100 000
       peoples (Ministry of Health- Manatū Hauora, 2017). While New Zealand’s general
       suicide rate has increased over the past four years, Māori men are disproportionately                                                                                                       Wellington
       represented in the statistics, with a 12 per cent increase of suicide deaths per
       100 000 people in the last year, according to provisional5
       data (Flahive, 2018).                                                                 SOUTH
                                                                                             ISLAND                                                                                        Christchurch

                                                                                                                                                                                             PACIFIC OCEAN

                                                                                                                                                                             AOTEAROA
                                                                                                                                                                            NEW ZEALAND

                                                                                                                                                         Map 3: Aotearoa/New Zealand.

       5        Provisional data is unreviewed or unedited data that has yet been finalised.

10 |   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
       CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
More recent 2018 provisional figures show an increase in Māori deaths compared to other populations,
as seen in the graph below (Flahive, 2018).

                                                                            Suicide Rates, New Zealand (Provisional)
                                              26
Number of Suicide deaths per 100 000 People

                                              24
                                              22
                                              20
                                              18
                                              16
                                              14
                                              12
                                              10
                                               8
                                               6
                                               4
                                               2

                                               2008   2009           2010    2011       2012   2013        2014   2015     2016   2017   2018

                                                             Asian                  Māori             Pacific            Other

Table 4: Suicide Rates Aotearoa/New Zealand (Provisional). Provisional figures for Aotearoa/New Zealand adapted
from the data by the Ministry of Justice. ‘Other’ represents all other peoples not identifying as Asian, Māori, or Pacific
(Flahive, 2018).

Youth
The most recent Child and Youth Mortality Review Committee’s report on suicide between 2002-2016
found that Māori children aged between 10 to 14 accounted for 60 percent of all suicides in that age
group (New Zealand Mortality Review Data Group, 2018).

Considering around 45% of the Māori population are aged between 0-19 years, youth suicide is of major
concern.

Risk Factors
Social and cultural factors, historic disadvantage, discrimination, prejudice and exclusion have been linked
with Māori suicides. Māori-specific suicide prevention frameworks have been developed as effective
strategies to prevent youth suicide (Best Practice Advocacy Centre NZ, 2010).

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                                                                            CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
TURTLE ISL AND:
                            NORTH AMERICAN CONTINENT

                                                                            Some Indigenous peoples from across the Americas share similar
                     BRIEF TIMELINE                                         creation stories around the formation of what is widely accepted as
           The First Nations, Metis and Inuit                               North America6. Turtle Island is home to many First Nations bands,
           peoples lived on the northern half of                            with some groups transcending the US and Canadian border- as
           North America since approximately                                modern geopolitical borders are a colonial construct and not definitive
           12,000 years ago.                                                of tribal boundaries or lands. Suicide rates across North America/Turtle
                                                                            Island differ depending on the region, and some groups have stronger
           First Nations peoples lived in organised                         data on suicide deaths than others.
           societies across North America;
           maintaining sustainable economies,
           politics and rich spiritual beliefs and                          CANADA
           cultures.
                                                                            Overview
           1600-1700’s: The French and British                              Canada has an estimated population of 36.7 million people, with
           colonised/invaded and fought over                                approximately 1.7 million people identifying as Aboriginal persons in
           modern day Canada. Systemic upheaval                             the 2016 Census (Statistics Canada, 2018c).
           and displacement of Indigenous peoples
           from traditional land through war, violence                      Historically, suicide was a rare occurrence amongst Indigenous
           and forced relocation.                                           Canadian people, and it was only after contact with Europeans and
                                                                            the effects of colonialism that suicide became prevalent (Kirmayer,
           1876: The Indian Act was passed,                                 2007). The higher rates of suicide in Indigenous communities has been
           controlling First Nations through forced                         linked to historic trauma, cultural losses, and social upheavals that
           assimilation, removal of children,                               were a result of European settlement and colonisation (Public Health
           desecration of traditional lands and                             Agency of Canada, 2016).
           residential schooling.
                                                                            Disaggregated data for suicide deaths in Canada in Indigenous and
           1940’s and 1950’s: Inuit in Canada’s                             non-Indigenous populations is not readily available. The Canadian
           north displaced by European settlers for                         Government in the Working Together to Prevent Suicide in Canada:
           resources and military purposes.                                 The Federal Framework for Suicide Prevention has identified that there
                                                                            is a great need to enhance suicide information, including data and
           Ongoing impacts of colonisation place                            research as currently this information is fragmented, complex, and
           Indigenous Canadians as an at risk group.                        difficult to access (Public Health Agency of Canada, 2016).
           Higher rates of physical and mental illness,
           compared to non-Indigenous Canadians.                            Indigenous Populations
           Suicide rates can often be extremely high,                       Canada has three distinct Indigenous groups. First Nations, Métis, and
           whereas, before the 19th century suicide                         Inuit making up 4.9% of Canada’s total population (IWGIA, 2018).
           was extremely rare amongst Indigenous
                                                                            First Nations, Inuit, and Métis are collectively referred to as Indigenous
           Canadians.
                                                                            peoples (Centre for Suicide Prevention, 2013). It needs to be
                                                                            recognised that in some circumstances;
           Canada is home to approximately
           1.7 million Indigenous people. They                              …terms may differ from those used by individuals to self-identify. For
           make up approximately 4.9% of the                                example, the NunatuKavut Community Council refers to the group it
           total population.                                                represents as “Southern Inuit” although individually some community
           (The Canadian Research Institute for the Advancement
                                                                            members may use the terms ‘Métis’ or ‘Inuit-Métis.’ (Pollock, Mulay,
           of Women, 2016; Canada Guide, 2018; Indigenous                   Valcour & Jong, 2016)
           and Northern Affairs Canada, 2018)

       6       The North American continent includes all Provinces and Territories of Canada, and the mainland States of the United States of America including the
               State of Alaska; however, does not encompass the State of Hawai’i and Other Pacific Islands.

12 |   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
       CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
Statistics representing Indigenous groups of Canada are not always readily available, however, the
    distinctions in suicide rates between these groups are made clearer below.

                                                                Suicide Rates: First Nations, Inuit and Overall Canadian Population
                                              160
                                                                                                           135
Number of Suicide deaths per 100 000 People

                                              140

                                              120

                                              100

                                              80

                                              60

                                              40
                                                                       24
                                                                                                                                               12
                                              20

                                               0
                                                           First Nations throughout                 All Inuit Regions in                   Canada Total
                                                                Canada in 2000                      1999-2003 period                         in 2001

                                                                People

    Table 5: Suicide Rates: First Nations, Inuit and Overall Canadian Population at Various Periods. Table adapted from
    “The Human Face of Mental Health and Mental Illness in Canada 2006” (Government of Canada, 2006), showing the
    elevated suicide rates in Indigenous communities compared to the general population of Canada with the available data
    across various period between 1999-2003.

    Inuit Peoples
    uicide among Inuit in Canada began to rise in the 1960s, especially among the first generation of young
    people growing up in settled communities. Historically, there was no evidence of high suicide rates in Inuit
    communities (Public Health Agency of Canada, 2016).

    Inuit Nunangat is the homeland
    of Inuit of Canada. Inuit Nunangat                                                                      ARCTIC OCEAN
    encompasses the land, ice, and
    sea of the Inuit communities
                                                                                                       INUVIALUIT
    located in the four Inuit regions,
                                                                                                          Beaufort
    Inuvialut, Nunavut, Nunavik,                                                                            Sea                                               Baffin Bay

    Nunatsiavut (Inuit Tapiriit                                                                                                                              Clyde River

    Kanatami, 2009). The population
                                                                                                                                                                       Baffin Island
    of Inuit Nunangat is around 86%
    Aboriginal identifying peoples7                                                           Yukon                                                                            NUNATSIAVUT
    (Li & Smith, 2016).                                                                                      Northwest           NUNAVUT
                                                                                                             Territories                                                               Newfoundland
                                                                                                                                                                                        & Labrador

                                                                                                                                                Hudson Bay
                                                                                                                                                               NUNAVIK

                                                                                                                     CANADA
                                                                                                                                                                           QUEBEC

                                                                                                                             USA
                                                                                                       Map 4: Inuit Nunangat Regions in Canada.

    7                                               Largely Inuit population, with a small percentage of First Nations and Métis peoples

                                                                                                                             GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 13
                                                                                    CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
Data shows Inuit communities have significantly higher suicide rates than First Nations and Métis populations
                           (Public Health Agency of Canada, 2006). Inuit Nunangat have rates of suicide between 5-25 times the rate
                           of suicide compared to mainstream rates for the whole of Canada (Inuit Tapiriit Kanatami, 2016). A more
                           specific figure according to the Canadian Government shows suicide in Inuit Nunangat is more than six times
                           higher than the rate in non-Indigenous regions (Webster, 2016).

                                                                                                                           Inuit Regions Suicide Rates
                                                                               140
                       Number of Suicide deaths per 100 000 People

                                                                                             120.3
                                                                               120

                                                                               100

                                                                                                                              76.9
                                                                                80

                                                                                60

                                                                                40                             31.1
                                                                                                                                                       17.1
                                                                                20                                                                                                   11.2
                                                                                                                                                                      5.3

                                                                                 0
                                                                                                Inuit Nunangat (Inuit Regions)                                       Overall

                                                                                                 Males             Females           Total

                           Table 6: Inuit Regions Suicide Rates between 2004-2008. Inuit Nunangat (Inuit Regions with high Inuit Population)
                           and overall Canada data for the 2004-2008 period collected from Statistics Canada (2018a). Indigenous and non-
                           Indigenous disaggregated data is currently unavailable.

                           More recent figures released in 2016, show Inuit Nunangat had a suicide rate of 73.6 per 100 000 peoples
                           compared to the mainstream Canadian suicide rate of 10.8 per 100 000, showing a slight decrease
                           (Pollock, Mulay, Valcour & Jong, 2016).

                           First Nations Peoples
                           First Nations identify as status and non-status Indians living on and off reserves, with around 614 First
                           Nations bands8 (Olson, 2013; Public Health Agency of Canada, 2006). The figures show the comparison
                           of suicide rates between First Nations peoples and the general population over the 1979-2000 period
                           (Kirmayer, 2007).

                           Figures collected over the 1993-2009 period suggest First Nations people experience suicide rates at 31.8
                           per 100 000 people in some regions (Pollock, Mulay, Valcour & Jong, 2016).

                                                                                      Comparison of Suicide Rates of First Nations and General Canadian Population
                                 Number of Suicide deaths per 100 000 People

                                                                                40

                                                                                30

                                                                                20

                                                                                10

                                                                                 0

                                                                               1979-1981         1982-1984            1985-1987         1988-1990         1991-1993             1999               2000

                                                                                                     First Nations (Status Indian)       General Population

                           Table 7: Comparison of Suicide Rates of First Nations and Overall Canadian population between
                           1979-2000. Graph adapted from Kirmayer (2007).

                           8                                                     Bands refers to a group or tribe of First Nations or Indian people. Sometimes referred to as a basic unit of government
                                                                                 representing the group.
14 |   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
       CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
Métis Peoples
Métis peoples identify as a group of people of mixed First Nations and European ancestry, distinct from
First Nations, Inuit, and non-Aboriginal peoples (Public Health Agency of Canada, 2006). There is currently
no available suicide data specific to Métis-identifying peoples.

Youth Suicide
Suicide is responsible for 40% of deaths in Inuit youth, compared with 8% across Canada (Webster,
2016). Rates for Inuit youth in some areas are up to 40 times the national average (Crawford, 2016).

Regional Disparity
The highest age-standardised mortality rates in
Canada are in Aboriginal subregions in Labrador
with the highest region reaching 165.6
suicide deaths per 100 000 people               ARCTIC
(Pollock, Mulay, Valcour & Jong, 2016).         OCEAN
Labrador is a part of Canada’s
easternmost province              ALASKA
Newfoundland and
Labrador (IWGIA, 2018).
                                                                                                                                                 ATLANTIC
                                                      NORTHWEST                       NUNAVUT
                                                                                                                                                  OCEAN
                                                      TERRITORIES
                                                                                                                                                  NE
                                                                                                                                                       W
Risk Factors                                                                                                                                               FO
                                                                                                                                                             UN
Research indicates an important                                       CANADA                                                                                    DL
                                                                                                                                                                     AN
link between suicide risk and                                                                          Hudson Bay                                                      D

trauma resulting from                       BRITISH
                                                            ALBERTA

                                           COLUMBIA
assimilative policies with
                                                                                AN

                                                                                                                             QUEBEC
                                                                                           MANITOBA

                                                                                                                     James
                                                                      SASKATCHEW

the legacy of colonisation PACIFIC                                                                                    Bay
in some Aboriginal           OCEAN
                                                                                                           ONTARIO
communities                                                                                                                       Ottawa

(Public Health Agency                                                                                                          Toronto

of Canada, 2016).                                                                                                                             NEW
                                                                                                                                           BRUNSWICK
                                                                                     USA
Inuit people and other Indigenous Canadians are 8 times
more at-risk and vulnerable to adverse social determinants,
such as living in overcrowded homes, that has an impact on                                            Map 5: Canada, with regions including
peoples mental and physical health (Webster, 2016).                                                   Newfoundland and Labrador shown.

Other risk factors include;

•   A lack of resources including food,
•   Lack of access to basic health care facilities,
•   High rates of mental trauma rooted in forced settlements and residential schooling as a result of
    colonisation (Olson, 2013),
•   High rates of abuse and childhood adversity (Webster, 2016).

                                                                         GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 15
                                CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
BRIEF TIMELINE
                                                                             UNITED STATES OF AMERICA
            Native American peoples have been in
            North and South America for at least                               Overview
            30,000- 40,000 years.                                              The United States of America’s current population is estimated at
                                                                               around 328 million people (United States Census Bureau, 2018).
            American Indian peoples lived in harmony
                                                                               America includes the modern borders on the North American
            with nature, with in-depth cultural history
                                                                               continent, the State of Alaska, and the State of Hawai’i. American
            and the development of agricultural farming
                                                                               Samoa, Guam, the Marshall Islands, Palau, the Federated States
            and extensive inter-group trade.
                                                                               of Micronesia, and the Northern Mariana Islands are included
            1492: European invasion began, beginning                           as associated states or territories of the USA. The Indigenous
            the process of colonisation of the ‘New                            peoples of these associated states or territories are represented
            World’.                                                            under the broader term ‘Other Pacific Islanders’ in demographics
                                                                               documentation.
            The American Indian population was
            about 240,000 in 1890, dropping from an                                                           CANADA
            estimated 8 million.
                                                                                                                         NORTH
            1778 to 1871: There were more than                                                           MONTANA         DAKOTA
                                                                                                                                                                          NEW
                                                                                                                                                                          YORK
            500 treaties signed between the USA                                                                          SOUTH
            government and Native American tribes,                                                                       DAKOTA                                                  Washington DC

            with all these treaties being violated in some
            way by the USA government.
                                                                                                     UTAH
                                                                                    CA

                                                                                                               COLORADO
            1800’s: With Native American peoples
                                                                                      LIF
                                                                                        O

            resisting the invasion of their traditional
                                                                                         RN

                                                                                                               NEW             OKLAHOMA
                                                                                            IA

            lands and desecration of culture, the                                                ARIZONA      MEXICO                                                       ATLANTIC
            governments of the USA stripped                                                                                                                                 OCEAN
            Native American tribes of their land and
            sovereignty; confining them to reservations
            and legally controlling their movements and                                     ALASKA
            freedom.
                                                                                                          HAWAII
            Children were forcibly removed from their
            families and culture into residential schools,
            Indigenous religious practices were
                                                                                                                          MEXICO
            prohibited on reservations and traditional
                                                                               Map 6: The United States of America.
            hunting rights and practices were restricted.
                                                                               Simplifying America’s population into Indigenous and non-Indigenous
            Ongoing effects of colonisation place
                                                                               peoples does not capture the complexity of America’s history and
            American Indian peoples as a risk group,
                                                                               the ethnic demographics of the current population. A snapshot of the
            with heightened rates of physical and
                                                                               history of colonisation in the USA is provided for context.
            mental health issues and suicide.
                                                                               Indigenous Populations
            Today, there are approximately 6 million
                                                                               The American Indian9 and Alaska Native population is estimated
            Native Americans in the USA, making up
                                                                               to be around 2.5-6 million people (IWGIA, 2018). There are 573
            2% of the American population in 2015.
                                                                               American Indian/Alaska Native tribal entities in the US (Indian Affairs
            (Pauls, 2018; Scholastic, 2018; Infoplease, 2017)                  Bureau, 2018). Native Hawaiians10 and Other Pacific Islanders have
                                                                               an estimated population of 1.2 million people (Hixon, Hepler & Kim,
                                                                               2012).

       9        Data sources overwhelmingly use the term ‘American Indian,’ however ‘American Indian’ and ‘Native American’ are interchangeable terms for the
                Indigenous peoples of the United States of America. ‘Alaska Native’ is a term specific to the Indigenous peoples residing and originating from the area
                encompassing the State of Alaska, and other self-identifying individuals.
       10       Native Hawai’ian peoples are the Indigenous Polynesian peoples that, before colonisation, lived in and exercised sovereignty in the modern American
                State of Hawai’i.

16 |   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
       CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
Suicide rates for Native American and Alaska Native peoples aged 15-24 years are twice as high as non-
    Indigenous Americans at 27.22 suicide deaths per 100 000 people (Rao, Pell & England-Kennedy, 2017).

    There are currently no estimates of suicide rates for the non-Indigenous population. These rates are more
    accurately comparable to the overall American population.

                                                          United States of America: 2016 Suicide Rates
                                              35   33.1
Number of Suicide deaths per 100 000 People

                                              30

                                              25
                                                                  21.4                               21.4

                                              20

                                                                                                                      13.5
                                              15
                                                          10.3             10.1
                                              10
                                                                                          6.7
                                                                                                             6.0
                                                                                   3.6
                                               5

                                               0
                                                    American Indian       Native Hawaiian and               Overall
                                                     /Alaska Native       Other Pacific Islander

                                                          Males          Females             Total

    Table 8: United States of America: 2016 Suicide Rates. Overall data sourced from the American Foundation of Suicide
    Prevention Indian/Alaska Native data sourced from Jiaquan et al. (2018). Native Hawaiian and Other Pacific
    Islander data sourced from Center of Disease Control and Prevention (2017). Note that in some instances, Native
    Hawaiian and Other Pacific Islander is also grouped with Asian population counts. Non-Indigenous figures currently
    unavailable.

    American Indian and Alaska Native Peoples
    Suicide among American Indians and Alaska Natives increased by 3% between 2014-2016.

    As reported in the 2016 National Healthcare Quality and Disparities Report (Agency for Healthcare
    Research Quality, 2017) suicide is the second leading cause of death for American Indian and Alaska
    Native populations between the ages of 10-34.

    In 2014, the suicide rate for non-Hispanic American Indian/Alaska Native males aged 25–44 was the
    highest among all racial and ethnic groups in the United States, at 48 per 100 000 peoples. This was 60%
    higher than in 1999 at 30 per 100 000 peoples (Curtin, Warner & Hedegaard, 2016).

    Native Hawai’ian
    At 26% of all fatal injuries, suicide is the most common cause of death among all Hawaiian residents
    (Hawai’i Health Data Warehouse, 2017). Further information is currently unavailable.

    Youth
    Native Hawai’ian peoples, particularly youth, have a higher prevalence of suicide attempts compared to
    non-Indigenous youth at 14.1% compared to 7.1% respectively (Galanis, 2016).

    Youth suicide in Native American and Alaskan communities is 70% higher than the rates of the general
    population of the United States (Herne, Bartholomew & Weahkee, 2014).

                                                                                                                   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 17
                                                                          CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
Elderly
                       American Indian and Alaska Native elders have lower rates of suicide than elders from other ethnic groups.
                       The reasons for this are hypothesised as cultural resilience and connectedness (Rao, Pell & England-
                       Kennedy, 2017).

                       Risk Factors
                       According to the Suicide Prevention Resource Center’s reports on suicide among racial/ethnic
                       populations, common risk factors for American Indians and Alaska Natives include:

                       •   Historical trauma- such as forced relocation, removal of children, prohibition of the use of native
                           languages and cultural traditions, and outlawing of traditional religious practices.
                       •   Alcohol and drug abuse
                       •   Disconnection from family and culture
                       •   Acculturation to mainstream culture
                       •   Discrimination and prejudice- with LGBT identifying peoples at higher rates of suicide deaths,
                           attempts, and ideation than their heterosexual counterparts- both Indigenous and non-Indigenous.
                       •   Community violence, with American Indian/Alaska Native youth at 2.5 times the exposure to trauma
                           that their mainstream counterparts
                       •   Lack of access to and use of mental health services (Suicide Prevention Resources Center, 2013).

18 |   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
       CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
CIRCUMPOLAR REGIONS

Indigenous peoples living in the circumpolar Arctic regions across Finland, Sweden, Norway, Russia,
Greenland, and North America have been found to account for some of the highest suicide rates in
the world. However, it is important to note there is great variance in the Arctic region within and across
Indigenous populations of different territories and contexts (Stoor, Kaiser, Jacobsson, Renberg & Silviken,
2015). For a more comprehensive understanding of this region, recommended reading is Suicide in
circumpolar regions: an introduction and overview (Young, Revich, & Soininen, 2015)

For Inuit Canadians see Canada
For Alaska Native peoples see United States of America

SÁPMI: SCANDINAVIA
Overview
Countries represented in Northern Europe or Scandinavia are Norway, Sweden, Finland and Russia. The
Sámi peoples refer to their Indigenous lands, that spread across these four countries, as Sápmi. However,
there is not a clear definition (I.e. accepted by the nation states) on where these lands begin and end. A map
developed by the International Work Group on Indigenous Affairs provides an overview (IWGIA, 2018).

     HISTORY OF SÁPMI                            Sámi Peoples
  Information about the history on the           Between 80 000 to 100 000 Sámi peoples are believed to
  colonisation of Sápmi is scarce and            live across Finland, Norway, Sweden, and Russia (Bacchi,
  incomplete. However, the Nordic                2017; Silviken, Haldorsen & Kvernmo, 2006). However,
  nation states (todays Norway,                  the Nordic countries do not allow registration of ethnicity,
  Sweden and Finland) and Russia                 including Sámi identity, in public records. This makes
  gradually seized control of Sámi               obtaining basic demography of the Sámi population
  lands through advancing from the               complicated and obtaining continuous and updated
  south and along the shores of the              statistics on suicide and other health statistics
  Gulf of Bothnia and the northern               impossible (Sámi Norwegian National
                                                                                           Finnmark
  Atlantic. Violent policies of both             Advisory Unit on Mental Health and
  discrimination and assimilation were           Substance Abuse
  part of the colonization. Today, the           & Saamicouncil, 2017).
                                                                                                                Inari
  Sámi are in minority throughout                                             Girjas                                         Kola Peninsula
                                                 Knowledge on            Sárri village
  their homelands, except in small               suicide among                                                 Rovaniemi
  municipalities in northernmost                 Sámi are therefore                                  Kallak
  Norway.                                        based on cohort studies
                                                 comparing suicides in
majority populations with those of Sámi ethnicity in Sámi areas Norway
                                                                                                                                   RUSSIA
(Silviken, Haldorsen & Kvernmo, 2006), Sweden (Hassler et al,
                                                                                                                FINLAND
2005) and Finland (Soininen & Pukkola, 2008), respectively. Even
though the information is outdated, these statistics are still the
best available and show that generally, suicide is higher among        NORWAY                                 Helsinki
Sámi than majority populations in the same periods.                       Oslo
                                                                                         Stockholm
                                                                                       SWEDEN                           ESTONIA
                                                                   DENMARK
                                                                                                                        LATVIA
                                         Map 7: Sápmi region,
                                         Northern Europe.                                                     LITHUANIA

                                                                                                                                   Sápmi

                                                                         GERMANY                POLAND

                                                                         GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 19
                                CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
Northern Norway 1970-1998
                           It was reported an increased suicide risk amongst Indigenous Sámi in Arctic Norway between 1970-1998
                           study, as compared to the overall reference population. In particular, males between 15-24 were at the
                           highest risk at a rate of over 50 suicide deaths per 100 000 people as seen in Table 9 below (Silviken,
                           Haldorsen & Kvernmo, 2006).

                                                                                            Suicide Rates in Sámi, Northern Norway
                                                                     60
                       Number of Suicide deaths per 100 000 People

                                                                     50

                                                                     40

                                                                     30

                                                                     20

                                                                     10

                                                                      0
                                                                          0-14      15-24        25-34      35-44       45-54        55-64   65-

                                                                             Male     Female               Age Group

                           Table 9: Suicide Rates in Sámi, Northern Norway. Adapted from Silviken, Haldorsen & Kvernmo (2006).

                           Northern Sweden 1961-2001
                           Reindeer herding Sámi men, in particular, were at a significantly higher risk of suicide between 1961-1980.
                           Reindeer herding and non-reindeer herding Sámi cohorts presented similar mortality rates when compared
                           to the reference population. This indicated significant differences between the Sámi and the overall
                           reference population. Hence the difference is not solely due to regional disparity (Hassler et al., 2005).

                           Northern Finland 1979-2005
                           Traditional Sámi nomadic lifestyles including reindeer breeding, hunting and gathering, ceased around the
                           1960s, with Sámi people’s health still being affected by the change. Although suicide occurred among
                           some Indigenous groups in the Arctic, it was rare, and the rate has increased in more recent years.
                           Between 1979-2005 suicide amongst Sámi men was 70% more common than the general population
                           (Soininen & Pukkola, 2008).

                           Youth and Culture
                           In Sweden, suicidality has been found to be more common among young adult Sámi (Omma, Sandlund
                           & Jacobsson, 2013), and reindeer herding Sámi (Kaiser & Salander Renberg, 2012), with strong themes
                           around suicide as a consequence for losing, or having lost Sámi identity, fighting for Sámi culture, and
                           difficulties in getting help as a Sámi person (Stoor, Kaiser, Jacobsson, Renberg & Silviken, 2015).

                           Risk Factors
                           The diversity of the Sámi populations and different contextual factors in different countries makes it hard
                           to provide a general overview of risk factors for suicide among Sámi. However, the Plan for Suicide
                           Prevention among Sámi in Norway, Sweden and Finland (Sámi Norwegian National Advisory Unit on
                           Mental Health and Substance Abuse & Saamicouncil, 2017) put forth eleven strategies for suicide
                           prevention including the need to protect and strengthen Sámi culture in order to strengthen resilience to
                           suicide, as well as prevent discrimination and violence against Sámi peoples. Similar to other Indigenous
                           groups, acculturation, a loss of culture and communities have attributed to higher suicide rates.

                           Russia experiences roughly 30 000 suicide deaths per year and around 10 times more attempt suicide.
                           Whilst Sámi people’s traditional lands are on the Kola peninsula in the Northwest of Russia, many other
                           Indigenous groups inhabit Russia. Sources from Indigenous groups across Russia suggest elevated
                           suicide rates may have connections to a lack of sense of Indigenous belonging, a lack of strengthened
                           cultural identity, and weakened resilience (Sumarokov, Brenn, Kudryavtsev & Nilssen, 2014).

20 |   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
       CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
PREFACE: Greenland attained self-governance in 2009, and while this makes it different to other countries in this project
the ongoing repercussions of historical colonisation reflects the same reality for Indigenous peoples in colonised countries.
Despite differences, Greenland is included in this paper due to the elevated suicide rates of Inuit Greenlanders.

        BRIEF TIMELINE
                                                    KALAALLIT NUNAAT: GREENLAND
  Greenland Inuit people make up
  the majority of the Greenland                   Overview
  population.                                     The Inuit people of Greenland suffer some of the highest rates of suicide in the
                                                  world, with 82.8 suicide deaths per 100 000 people reported in 2015 (Hersher,
  1720s: Modern colonisation of                   2016). Of the 55 860 citizens of Greenland, 90% are Inuit, descendants of the
  Greenland. The Danes used the                   Thule people and related to Inuit people in other polar regions (Bolliger & Gulis,
  term ‘colony’ as synonymous with                2018). Albeit different from the relationships between coloniser and colonised
  mission and trade station.                      regions in other countries, Greenland’s colonial history, and subsequent
                                                  sociocultural change has impacted significantly on suicide rates (Bjerregaard &
  Community ownership of the land
                                                  Lynge, 2006).
  was interpreted by the Danish as
  ‘no ownership’ or ‘crown land’.
                                                  Overall Rates
  As a result, in 1850 mines were
  established without permission                  Rates of suicide in men are 4.3 higher than women in Greenland, with young
  from Inuit Greenlanders.                        men at the highest risk nationally (Hersher, 2016; Bjerregaard & Lynge, 2006).

  1953: Colonial status of Greenland              Risk Factors
  formally ended.                                 The biggest factor in changes in mental health and suicide rates in these time
                                                  periods was the change from subsistence fishing to a living based on wage-
  Inuit Greenlanders were forced
                                                  earning. Relocation to larger communities, a change in family structure, and
  to learn Danish and their native
                                                  discrimination between Inuit Greenland from remote areas and more urban-
  language was taught as an
                                                  living peoples have contributed to higher suicide rates and mental health
  elective.
                                                  concerns (Bjerregaard & Lynge, 2006).
  Racial discrimination systematically
  in place with Danish employees
  paid higher wages.                                        CANADA                                       SVALBARD
                                                                                                         (NORWAY)
  2009: Greenland attained
  self-government, however
  the Inuit community still suffer                            QAANAAQ
                                                               (Thule)
  from colonisation and a rapid                                     Qaasuitsup
  modernisation period. Greenland                                   Kommunia          National Park
  has some of the highest suicide
  rates in the world.
                                                         UPERNAVIK
  (Peterson, 1995: Ringgaard, 2016)
                                                                                                         ITTOQQORTOORMIIT

                                                       UUMMANNAQ

                                                                                     Kommuneqarfik
                                                     QEQERTARSUAQ        ILULISSAT
                                                                                      Sermersooq
                                                                        QASIGIANNGUT
                                                      KANGAATSIAQ
                                                          SISMIUT     KANGERLUSSUAQ
                                                                                                                ICELAND
                                                                        Qeqqata
                                                       MANIITSOQ                     TASILAQ
                                                                       kommunia

                                                            NUUK
                                                                                               KALAALLIT NUNAAT
                                                           PAAMIUT                               GREENLAND
                                                                           NARSAQ
                                                            IVITTUUT
                                                           QAQORTOQ                        Kommune
                                                                NANORTALIK                  Kujalleq

                                                      Map 8: Kalaallit Nunaat/Greenland.

                                                                               GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES | 21
                                      CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
APPENDICES

                                                                                                       APPENDIX 1:
                                                                           TA B L E : S U I C I D E D ATA F O R O V E R A L L P O P U L AT I O N S
                                                                                             AT L AT E S T AVA I L A B L E Y E A R
                                                                                       Suicide Data for Overall Populations at Latest Available Year
                                                                     30
                       Number of Suicide deaths per 100 000 People

                                                                     25
                                                                                                                  21.4                                         21.9
                                                                          19.1
                                                                     20
                                                                                              16.3                                       16.4
                                                                                                                                                                            13.7
                                                                     15                                                          13.5
                                                                                       12.6
                                                                                                           11.0                                       11.1

                                                                     10
                                                                                 6.2                                       6.0                  6.1                   6.5
                                                                                                     5.7
                                                                      5

                                                                      0
                                                                          Australia (2017)    Canada (2016)         USA (2016)          NZ/Aotearoa (2015)     Northern Europe
                                                                                                                                                             /Sápmi (Mean Value)

                                                                                 Males           Females           Total

                           Table 10: Overall suicide rates here include the mainstream population and the Indigenous population. Australia
                           (Australian Bureau of Statistics, 2018); Canada (Public Health Agency of Canada, 2016), USA (Center of Disease
                           Control and Prevention, 2017), NZ/Aotearoa (Stats New Zealand, 2017), Northern Europe/Sápmi (OECD, 2017).

22 |   GLOBAL OVERVIEW: INDIGENOUS SUICIDE RATES
       CENTRE OF BEST PRACTICE IN ABORIGINAL AND TORRES STRAIT ISLANDER SUICIDE PREVENTION
REFERENCES
A working definition, by José Martinez Cobo. (2011). [Blog]. Retrieved from https://www.iwgia.org/en/news-alerts/archive/143-uncategorised/340-a-working-
       definition-by-jose-martinez-cobo
Agency for Healthcare Research and Quality. (2017). 2016 National Healthcare Quality and Disparities Report. Rockville: AHRQ. Retrieved from https://www.
      ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhqdr16/final2016qdr-cx.pdf
American Foundation for Suicide Prevention. (2016). Suicide Statistics. Retrieved from https://afsp.org/about-suicide/suicide-statistics/
Australian Bureau of Statistics. (2018a). “3303.0- Causes of Death, Australia, 2017.” Retrieved from http://abs.gov.au/ausstats/abs@.nsf/Lookup/by%20
        Subject/3303.0~2017~Main%20Features~Intentional%20self-harm,%20key%20characteristics~3
Australian Bureau of Statistics. (2018b). “3303.0 - Causes of Death, Australia, 2017. Intentional self-harm in Aboriginal and Torres Strait Islander People.”
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