Over 16 per cent of youth treated in emergency rooms across the province for self-harm are First Nations. But as “alarming” as that figure is, Dr. Amanda Newton, University of Alberta researcher and associate professor in the Department of Pediatrics, says the number for Aboriginal youth is higher yet.
“We might be underestimating the problem … just in what we know about self-harming in general amongst children who are First Nation, Métis or Inuit,” she said. “It really is pause for reflection to think about why we are seeing these visit rates.”
The figures presented are for Treaty status First Nations youth 18 years and younger, who visited the province’s 104 emergency rooms from 2002-2011. Alberta Health Services did not separate data for non-status, Métis or Inuit youth.
“We have a lot of young ones that have gone through so much trauma and some of the reactions to trauma does come from that place,” said Russell Auger, who works with youth in Spirit of Our Youth Homes, in Edmonton. The organization operates six houses, which each house five children, from newborn to 22 years old. The organization’s mandate is to reunite children with their families. Auger has been working with the youth for almost eight years. “The self-harm they’re creating is, ‘I have to do something to feel as if I am alive.’ A large part of it comes from that.”
Self-harm, according to Newton’s study, refers to non-fatal self-poisoning, such as alcohol or drug abuse, or self-injury, such as cutting, regardless of whether the intent was deliberate suicide.
While the study, spearheaded by U of A medical student Conrad I. Tsang, does not examine the reason behind the high numbers of First Nations children, who self-harm, Newton says it is important to have that discussion. Presently the assessments undertaken in the emergency department don’t take into consideration social, psychological, and motivational factors. One of the recommendations made by the study, says Newton, is for clinicians to “think about the context in which (the self-harm) occurred.”
The study states that “social determinants are hypothesized to be at the root of health differences faced by Aboriginal children compared to their non-Aboriginal peers.”
Auger agrees. The children he deals with come from homes that are in rough shape and overcrowded, where income is low, substance abuse is high, and their care is not a priority. Many of the children come from abusive homes.
The study also found that it takes First Nations children 39 days, on average, to follow their emergency room visit with an appointment with a physician. The report states, “Our follow-up care findings may contribute to understanding why death by suicide (mortality) rates are disproportionately higher in Aboriginal boys and girls compared to the general population.”
The report also speculates that First Nations children may be getting help elsewhere, including following their cultural roots and seeking traditional help. But even if that were the case, Newton points out that the figures for self-harming are still high.
Auger says continuity is an issue, as children are often shuffled from one care home to another. As well, culture provides a barrier for children who live on reserve, making them uncomfortable talking to a non-Native.
Auger is adamant that there needs to be more Aboriginal people involved in the health system.
Auger has a higher chance of connecting with the youth because of his cultural and ethnic background and shared experiences. However, he admits, there are still times when the youth remain closed.
“They’re really secretive about it. It becomes like a challenge because when they open up, they don’t want to let people know they’re still (cutting themselves),” he said.
Newton’s study is a call for action and provides valuable information.
“The results are always good to have because you can say to government, you can say to policy makers, ‘This is the problem.’ Evidence can serve people well when you’re armed with it,” she said.
Newton will now be involved in making the findings public and getting the results onto the appropriate desks of those who can make changes.
“We are a government in transition and the NDP are sensitive to a lot of social policies and social programs and that could match up very well,” she said.
The study, “Emergency health care use among sociodemographic groups of children presenting to emergency departments for self-harm in Alberta,” was published in the March edition of the Canadian Journal of Emergency Medicine. Along with examining First Nations youth, the study distinguished between children whose families received government subsidy, human services program subsidy, or no subsidy.