The Possibility for Change

The topics of mental health and suicide were never discussed when I was growing up in my small First Nations community, Behchokò, N.W.T., west of Yellowknife. I knew these topics were considered taboo. But as an adult and a community and public health nurse, I wanted to know why mental health was so difficult to speak about, at a time when too many of our youth are dying by suicide. I recently posed this question to an Elder from my community, and the answer proved to be enlightening and heartbreaking. But it opened the possibility for change.

Tłıcho, our ancestral region, covers about 40,000 square kilometres stretching north of Great Slave Lake. There are about 3,000 people living in four communities there. Throughout my childhood, I don’t recall an adult ever openly talking about suicide or mental health. If someone was known to have a mental illness, we kids were warned not to go near that person.

If a death occurred in my region that wasn’t accidental or expected, nothing was said beyond, “So-and-so was found dead, it’s so sad.” No one ever said suicide. Even today, despite mental health issues being covered in mainstream media, the stigma remains in my region. Some people don’t seek counselling. Young adults often internalize the message, “Just deal with it,” even when they reveal they’re depressed. Where counselling services in small communities are available, people are reluctant to go due to a lack of anonymity.

Can you imagine any other public health crisis being treated this way? For context, my home community had four deaths by suicide in the span of three months in 2022. My mom worked as a language and culture co-ordinator until she retired recently. Once, before she went to a sharing circle to discuss strategies addressing mental health issues, she asked me to define “mental health” to translate it to Tłıcho Elders. It got me thinking that it’s hard to have discussions about mental health when some community members can’t even say, “suicide.” How are we supposed to help anyone?

That’s why I had the conversation with a community Elder: I wanted to understand why the topics of mental health and suicide are stigmatized. At first, the Elder skirted the topic, speaking about it in a round-about way. I asked why it was common in our region to call someone “crazy” rather than say they have a mental illness. I asked her what kind of example we set for young people and how we’re supposed to support them when we can’t even talk about the problem. So the Elder offered her explanation.

Fear and shame, she said, are why the older generation avoids the subject. She said in the 1950s and ’60s, when a person died by suicide, the surviving family would attempt to hide the cause of death. They were afraid of being blamed, afraid of getting in trouble. They were ashamed that they had family who suffered from mental illness. They were ashamed about the circumstances that led to the suicide and of how that person might have led their life. Sometimes gossip can label a person for life.

Related to this, mental illness was once lumped together with developmental delay. And a developmental delay meant that a young person could be taken from their family. The Elder I spoke to recalled knowing a child who was developmentally delayed. His family, due to lack of education and resources, was unable to care for him. At age eight or nine, the Elder said, he was “taken by the missionaries” to a residential care facility. He came home to visit once the following summer and then never again. The Elder surmised that he died in care, or was sent to a facility in southern Canada. Families, she explained, were afraid to risk losing loved ones this way, so they didn’t talk about either developmental delays or mental health problems.

Things are changing. As an Indigenous nurse, to do my job effectively and safely, I speak openly with patients about things some people consider taboo. When I’m taking a person’s medical history, I ask about everything. I ask about menstruation, reproduction and sexual health. If a person is admitted for suicidal ideation, I ask if they have a plan. For someone from a small community, I’ve learned to get comfortable asking hard questions. Health-care providers need to talk about mental health care and community support when cultural considerations make the conversation difficult. We need to lose the stigma. I don’t have all the answers, but I think it’s a good start to normalize conversations about mental health and suicide. Fortunately, some Elders in my community, like the one I spoke to, are starting to agree. We support our community when we open the conversation.

Lianne Mantla-Look is the first person from the Tłıcho region of the Northwest Territories to become a registered nurse. She lives and works in Yellowknife.