Atlas›Domain XI · Traditional medicine & indigenous healing›Guide 043
Guide XI-043

Inuit angakkuq

Inuit lands (Nunavut and elsewhere)
A 38 · L 51 · M 1117 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: the angakkuq tradition as Inuit Elders' testimony and Inuit-produced education materials describe it, with Laugrand and Oosten (2010) as attributed scholarly context. The clinician's work follows Inuit-led frameworks: the Inuit Tapiriit Kanatami (ITK) National Inuit Suicide Prevention Strategy (2016), the Government of Nunavut's eight Inuit societal values, and Inuusivut Anninaqtuq (2017–2022). Assessment uses the DSM-5-TR Cultural Formulation Interview (CFI).

What it is. The angakkuq (plural angakkuit) is the shaman of Inuit tradition. An Inuit-produced IsumaTV/SILA lesson plan, drawing on Elders' interviews, describes angakkuit as healers, doctors and advisers. They were born with and skilled in seeing spirits. They were specialists in unseen powers rather than priests, and they mediated between the human and spirit worlds and between the living and the dead. Their roles included curing illness and retrieving lost souls, working with helping spirits (tuurngait) to protect a community's health. These are Inuit spiritual understandings, described here as the tradition holds them. [source: IsumaTV, An Introduction to Shamanism] Scholarship by outsiders, based on Elders' accounts, describes the shaman's main roles as helping to procure game, healing the sick, correcting the weather and protecting the community. In that account healing was a "sociocosmic process" that involved confessing breaches of rules. [source: Anthropologica review of Laugrand and Oosten 2010, p. 196; outsider scholarship]

Historical and present status. Missionaries opposed shamanism. Many practices "went underground, but shamans never disappeared." Shamanism first continued alongside Christianity and then declined. Interest in it is now returning, and some Elders are reported to see Pentecostal and evangelical worship as close to shamanism. [source: Anthropologica review, pp. 195–197] Nunavut Arctic College's Elders' volume Cosmology and Shamanism says these aspects of Inuit culture were "in large part suppressed following the introduction of Christianity." [source: NAC Media, Cosmology and Shamanism] IsumaTV reports that about 80% of Inuit in Nunavut are Christian. [source: IsumaTV] Inuit organisations and services do not publish any current public angakkuq practice or referral pathway, and none is described here. [uncertain: not verified]

What this guide covers. This is a living spiritual tradition and a history held by Inuit. It is not a therapy. A psychotherapist does not practise it, imitate it or broker access to it. The guide covers the therapist's own culturally responsive work with Inuit clients. That work means understanding the client's explanatory model (which may include ancestral, spiritual, Christian or angakkuq-related meanings), working within Inuit societal values, and collaborating with the people and programmes Inuit communities sanction: Elders, Inuit counsellors and Inuit-led healing programmes. ITK frames suicide as rooted in historical trauma, social inequity and childhood adversity. In its framing, cultural continuity and Inuit knowledge are "a source of strength that can foster resilience." [source: ITK NISPS 2016, pp. 15–25, 37] How change happens in this frame: wellness grows through social equity, cultural continuity, healthy childhoods, access to a continuum of mental wellness services, healing unresolved trauma and grief, and mobilising Inuit knowledge, all led by Inuit. [source: ITK NISPS, p. 29] The therapist's part is to make individual care fit that frame. [synthesis]

Who holds authority. Cultural authority over angakkuq knowledge lies with Inuit Elders and communities. Nunavut Arctic College's Interviewing Inuit Elders series presents Elders as the keepers of this knowledge, and Elders are described as "respected keepers of knowledge." [source: NAC Media; Anthropologica review, p. 195] The institutions that set the frame for mental-health work are:

  • Inuit Tapiriit Kanatami at national level. [source: ITK NISPS]
  • The Government of Nunavut, which has adopted Inuit Qaujimajatuqangit (IQ) and eight Inuit societal values for legislation and policy. [source: GN Inuit Societal Values]
  • Nunavut Tunngavik Inc. and the Embrace Life Council, which partner on Inuusivut Anninaqtuq. [source: Inuusivut Anninaqtuq Action Plan]
  • Inuit-led services such as the Ilisaqsivik Society in Clyde River and the Isuarsivik Regional Recovery Centre in Kuujjuaq, Nunavik. [source: ITK, Our Life's Journey; Makivvik, Let the collective healing begin]

2. Framework

There is no staged protocol. The framework below is a care pathway built from the CFI, ITK's priority areas and the Nunavut action plan. It is offered as [synthesis]; its components are sourced as marked.

Phase A: Preparation (before first contact). Goal: know the local Inuit-led services and your own position.

  • Learn the region (Nunavut, Nunavik, Nunatsiavut or Inuvialuit), its language (Inuktut dialect) and its services. Examples: Inuktut counsellors, Our Life's Journey graduates, Elders' programmes, land-based programmes, Isuarsivik, community wellness hubs. [source: Inuusivut Anninaqtuq, 2-2 C, 2-3, 2-4, 3-3]
  • Arrange interpretation. [source: Nunatsiaq, Mental Health Act]
  • Move on when: you can name at least one Inuit-led resource and an interpreter route. [synthesis]

Phase B: Engagement and cultural assessment (sessions 1–3). Goal: understand the problem in the client's own terms.

  • Use the core CFI: 16 questions in four domains. Add supplementary modules or the Informant Version as needed. [source: APA CFI] The CFI supports clinical decisions and is not the only basis for diagnosis. [source: APA CFI]
  • Ask whether the client wants family involved, and whether they want a tikkuaqtaujuq (representative) recorded where the Nunavut Mental Health Act applies. [source: Nunatsiaq, Mental Health Act]
  • Move on when: the client's explanatory model, preferred helpers (family, Elders, church, Inuit counsellor) and language preference are recorded. Any unusual experiences must also be placed as culturally normative or as possible disorder, with a consultation plan if that is unclear. [synthesis]

Phase C: Collaborative planning. Goal: set goals by discussion and consensus (aajiiqatigiinniq) and place individual goals within family and community obligations.

  • Agree on the therapist's role alongside Elders, Inuit counsellors or programmes the client chooses. [source: Wihak & Merali 2003, pp. 248, 251–252; GN Inuit Societal Values]
  • Move on when: there is a shared plan the client describes in their own words, and consent covers any contact with other helpers. [synthesis]

Phase D: Ongoing therapy (typically weekly or fortnightly, often by telehealth in remote communities [uncertain: not verified]). Goal: reduce distress and strengthen the protective factors ITK names.

  • Work on trauma and grief, family relationships, safety and cultural connection. [source: ITK NISPS, priority areas 2–5]
  • Repeat the CFI modules when new meanings emerge. [source: APA Supplementary Modules]
  • Move on when: the client's goals are met by their own measure, or care moves to an Inuit-led service. [synthesis]

Phase E: Ending and continuity. Goal: hand over to supports that stay in the community. Examples: Elders, Inuit counsellors, grief groups, land-based and intergenerational programmes. [source: Inuusivut Anninaqtuq, 2-5, 3-3, 7-1, 8-4]

Format notes.

  • Allow time for the CFI. The field trial found that later interviews "required less time." A figure of about 15–20 minutes for the core CFI is [uncertain]. [source: Lewis-Fernández et al. 2017, abstract]
  • Sessions may include family members or an Elder at the client's request. [source: Wihak & Merali, pp. 248–249]
  • Suicide-risk review runs through every phase. [source: ITK NISPS, p. 25]

3. Guiding principles

The eight Inuit societal values come from the Government of Nunavut. Their wording is the Government's, and the practical meanings are [synthesis] unless another source is cited.

  • Inuuqatigiitsiarniq ("respecting others, relationships and caring for people"). Lead with relationship before tasks, and keep caring visible.
  • Tunnganarniq ("fostering good spirits by being open, welcoming and inclusive"). Make the room and the paperwork welcoming. Allow family and an interpreter.
  • Pijitsirniq ("serving and providing for family and/or community"). Explore the client's roles and obligations. Wihak and Merali recommend a self-in-relation view and planning for how family will react to individual goals. [source: pp. 247–248]
  • Aajiiqatigiinniq ("decision making through discussion and consensus"). Avoid expert directives. Treat the client as the expert on their own life, and consider including others the decision affects. [source: Wihak & Merali, pp. 251–252]
  • Pilimmaksarniq/Pijariuqsarniq ("development of skills through observation, mentoring, practice, and effort"). Build skills through practice and modelling rather than lecture. Wihak and Merali also stress the client's felt and revealed truth: validate the client's own interpretation of the problem and draw on how they solved problems before. [source: pp. 244–246]
  • Piliriqatigiinniq/Ikajuqtigiinniq ("working together for a common cause"). Coordinate with other helpers the client chooses rather than competing with them.
  • Qanuqtuurniq ("being innovative and resourceful"). Use the client's practical resourcefulness, and adapt the format (phone, the land, family meetings) to local realities.
  • Avatittinnik Kamatsiarniq ("respect and care for the land, animals and the environment"). Treat connection to the land as a resource, and support land-based programmes run by Inuit. [source: Inuusivut Anninaqtuq, 3-3]

[source: GN Inuit Societal Values]

Clinical principles.

  • Non-interference, understood rather than pathologised. Respect and non-interference serve group cohesion and are not simply passivity. They may not protect every member, though, so safety still comes first. [source: Wihak & Merali, pp. 249–250]
  • Inuit lead. Prevention and healing should be led by Inuit regions, communities and organisations. Your role supports Inuit-led efforts. [source: ITK NISPS, p. 37]
  • Trauma-informed and culturally safe. ITK asks that health and social services be trauma-informed and culturally safe. [source: ITK NISPS, pp. 29, 32]
  • Language is care. Identify the client's preferred language, including Inuit languages, and provide an interpreter. [source: Nunatsiaq, Mental Health Act]
  • Attribute, do not adjudicate. Describe spirits, souls and the angakkuq's work as the client and the tradition hold them. Do not affirm them as fact or dismiss them. [synthesis]
  • No performance, no brokering. Never perform, imitate, request or arrange angakkuq practices. Never ask a client to describe ceremonies, songs or other restricted knowledge beyond what they choose to share. [synthesis]
  • Respect diverse positions. Inuit hold a range of positions: many are Christian, some are reclaiming shamanic heritage, and some combine both. Do not assume which one a client holds. [source: IsumaTV; Anthropologica review, pp. 196–197]
  • Know the colonial history. Suppression of Inuit spirituality and colonial policies form part of the context of current distress. [source: ITK NISPS, pp. 15–17; Health Canada 2016]

4. Intervention inventory

All interventions below are the psychotherapist's own. None of them performs, imitates or requests angakkuq practice. Unless another source is cited, the steps are [synthesis] built on the sources named.

4.1 Cultural humility and positional self-examination

  • Purpose / when: Use before and throughout work with Inuit clients, especially if you are non-Inuit. The aim is to recognise how colonial history and missionary suppression of Inuit spirituality shape trust in services. [source: ITK NISPS, pp. 15–17; Anthropologica review, p. 195]
  • Steps:
    1. Read the ITK account of historical trauma: colonisation, forced settlement and their link to present distress. [source: ITK NISPS]
    2. Note your own assumptions about shamanism, Christianity and "traditional healing."
    3. In supervision, review cases for moments where you defaulted to expert direction against aajiiqatigiinniq.
    4. Name your outsider position plainly to the client where that fits.
  • Example language (illustrative): "I'm not Inuk, and I know health services haven't always respected Inuit ways. Please tell me if I get something wrong. I'd rather learn from you."
  • Watch for:
    • A client being polite but not engaging, which can signal mistrust.
    • Your own urge to romanticise or to correct the client's beliefs.
    • Working when: the client corrects you, adds context or brings family, which are signs of growing trust.

4.2 Mapping Inuit-led resources and authority

  • Purpose / when: At intake, so that collaboration rests on community-sanctioned pathways.
  • Steps:
    1. List local Inuit-led supports:
      • Inuktut-speaking counsellors.
      • Graduates of Ilisaqsivik's Our Life's Journey, an Inuit counsellors' training and mentorship programme with five modules (Modules 1–3 were delivered in the funded project). It combines Inuit knowledge and southern counselling, and Elders facilitate parts of it. [source: ITK, Our Life's Journey]
      • Elders' and intergenerational programmes, grief groups and community wellness hubs. [source: Inuusivut Anninaqtuq]
      • Land-based youth programmes such as Makimautiksat and the Arviat Young Hunters Program. [source: Inuusivut Anninaqtuq, 3-3 C]
      • In Nunavik, Isuarsivik, a family-based recovery centre in Kuujjuaq grounded in Inuit values and land-based activity. [source: Makivvik 2023]
    2. Record who in the client's community the client already turns to.
    3. Do not list or seek out an angakkuq. No public referral pathway is published by Inuit organisations or services. [uncertain: not verified]
  • Example language (illustrative): "Who do you usually go to when things are hard: family, an Elder, someone at church, a counsellor here?"
  • Watch for:
    • Services that exist on paper but are unfunded. The CBC reports Ilisaqsivik's training struggled for funding. [source: CBC]
    • Small-community confidentiality concerns.

4.3 Language access and working with interpreters

  • Purpose / when: Whenever Inuktut is the client's preferred language, and whenever it is unclear. The Nunavut Mental Health Act requires providers to identify the preferred official language and provide an interpreter. [source: Nunatsiaq 2021] Inuusivut Anninaqtuq commits to better Inuktut–English counselling interpretation, a mental-health terminology guidebook and interpreter training. [source: Inuusivut Anninaqtuq, 2-2 D]
  • Steps:
    1. Ask the client's language preference at the first contact.
    2. Brief the interpreter on confidentiality, and ask whether they know the client or the family.
    3. Agree how they will render terms that have no direct equivalent.
    4. Speak to the client, not the interpreter.
    5. Debrief the interpreter afterwards; distressing content affects them too.
  • Example language (illustrative): "Would you like to talk in Inuktitut, English or both? We can have an interpreter, and you can tell me if you'd prefer someone you don't know."
  • Watch for:
    • The interpreter softening or editing material.
    • Family members used as interpreters for sensitive topics, such as abuse or suicide. Avoid this.

4.4 Core Cultural Formulation Interview

  • Purpose / when: At first evaluation, to clarify the problem's meaning, sources of help and expectations from the client's perspective. Any clinician in any setting can use it. [source: APA CFI; APA Section III]
  • Steps:
    1. Introduce it as questions about how the client and the people around them see the problem.
    2. Cover the four domains [source: APA CFI]:
      • Cultural definition of the problem (Q1–3).
      • Cultural perceptions of cause, context and support (Q4–10), including cultural identity.
      • Self-coping and past help seeking (Q11–13), including barriers.
      • Current help seeking (Q14–16), including the clinician–patient relationship, such as perceived racism or language barriers.
    3. Use the APA form in your own care; clinicians may reproduce it for use with their patients. Modifying or translating it needs APA permission. [source: APA CFI]
    4. Summarise back in the client's words.
  • Example language (illustrative): "Sometimes people describe their problems in their own way, or in words their family or community use. How would you describe what's been happening?"
  • Watch for:
    • Short answers to questions about cause. Respect and non-interference may make clients reluctant to name others as causes. [source: Wihak & Merali, p. 249]
    • Answers about Q16 (the relationship with the clinician) that point to mistrust.
    • Working when: the client offers their own terms and meanings.

4.5 CFI supplementary modules and Informant Version

  • Purpose / when: In-depth assessment, at first evaluation, later or repeatedly. [source: APA Supplementary Modules] Relevant modules here:
    • Spirituality, Religion, and Moral Traditions: Christian, shamanic-heritage or mixed positions.
    • Explanatory Model.
    • Cultural Identity.
    • Social Network.
    • Coping and Help-Seeking.
    • School-Age Children and Adolescents.
    • Older Adults.
    • Caregivers.
  • Steps:
    1. Choose a module from the core CFI subtopic that needs expanding. [source: APA Supplementary Modules]
    2. Use the Informant Version (17 questions) with a family member the client agrees to. [source: APA Informant Version]
    3. Record the results as the client's account. Do not convert them into diagnosis.
  • Example language (illustrative): "You mentioned your grandmother's teachings and also church. Could we talk about what faith and tradition mean in your life now?"
  • Watch for:
    • Pressing for detail on ceremonies or restricted spiritual knowledge. Accept what is offered.
    • Intergenerational differences within one family.

4.6 Explanatory-model inquiry (Kleinman)

  • Purpose / when: When the client's understanding of cause or treatment differs from yours, or a spiritual, ancestral or angakkuq-related meaning is mentioned.
  • Steps:
    1. Ask Kleinman's eight areas in your own words [source: Kleinman et al. 1978, via Tanenbaum handout]:
      • name;
      • cause;
      • why now;
      • what it does;
      • severity and course;
      • treatment wanted;
      • chief problems;
      • main fears.
    2. Wihak and Merali advise trusting and validating the client's interpretation of the problem. Where it is relevant and the client agrees, consult Elders about culturally held causal explanations. [source: pp. 245–246]
    3. Negotiate a shared plan that holds both models.
  • Example language (illustrative): "What do you think caused this? … What do you most fear might happen? … What kind of help do you think would be right?"
  • Watch for:
    • Treating the client's model as an obstacle.
    • Signs of shame about "old ways" or about church views on them.
    • Working when: the client agrees to a plan they say fits how they see the problem.

4.7 Asking about spiritual experiences and other helpers without judgement

  • Purpose / when: Routinely, because clients may consult Elders, church leaders or family about spiritual matters, or may hold family memories of angakkuit.
  • Steps:
    1. Ask openly, in a normalising way.
    2. Accept a client's choice not to speak of spiritual matters. Ask permission before going further.
    3. Record only what the client agrees to have recorded.
    4. Never ask for songs, ceremonies or methods.
  • Example language (illustrative): "Some people I work with also get help from Elders, from church, or from their own family's ways. Is anything like that part of your life? You don't have to tell me details."
  • Watch for:
    • Conflict between Christian and shamanic-heritage meanings within the family. Do not take sides. [source: Anthropologica review, pp. 196–197]
    • The client testing whether you will mock or pathologise them.

4.8 Distinguishing culturally normative experience from disorder

  • Purpose / when: When a client reports spirits, the presence of deceased relatives, unusual perceptions or trance-like states.
  • Steps:
    1. Explore context. Ask whether the experience is understood and shared within the client's family, community or church, and whether it is wanted or distressing.
    2. Apply the culture clauses. DSM dissociative identity disorder (DID) may present as possession, but the criteria exclude experiences that are a normal part of broadly accepted cultural or religious practice. Dissociative trance under other specified dissociative disorder carries the same exclusion. [source: PMC9199574; Lewis 2023 study guide; exact DSM-5-TR wording uncertain] ICD-11 6B62 trance disorder and 6B63 possession trance disorder require the state to be involuntary and unwanted, outside accepted cultural or religious practice, and to cause distress or impairment. [source: findacode ICD-11 mirror; PMC9199574]
    3. Note history. DSM-5 removed pibloktoq ("Arctic hysteria") from its cultural-concepts glossary, reclassifying it with the dissociative disorders. Do not use it as an Inuit diagnosis. [source: Teodoro & Afonso 2020] DSM-5-TR lists no Inuit-specific cultural concept of distress. [uncertain: not verified]
    4. Consult a cultural broker, an Inuit counsellor or an Elder the client agrees to, without sharing identifying details unless consent covers it.
    5. Look for markers of illness: functional decline, disorganisation, risk, and distress the client or family see as outside normal experience.
  • Example language (illustrative): "In your family or community, how would people understand what you're experiencing? Is it something you want to keep, or something you want help with?"
  • Watch for:
    • Two errors: pathologising a culturally meaningful experience, and missing psychosis, mania, delirium or suicidal risk because it is framed spiritually.
    • Working when: the formulation is one the client and the consulted broker both recognise.

4.9 Values-informed collaborative goal setting and family involvement

  • Purpose / when: In planning and review, so that goals follow aajiiqatigiinniq (consensus) and pijitsirniq (service to family and community).
  • Steps [source: Wihak & Merali, pp. 246–252]:
    1. Elicit the client's collective narrative: their obligations and relationships.
    2. Derive goals together. If a goal is individual, prepare the client for how family or community may react.
    3. Ask whom the decision affects, and offer to include them. This can include network or family sessions.
    4. Review past times the client handled similar problems, and build on them in small steps.
    5. Frame change in terms of the client's role in the family, which can mobilise others' help.
  • Example language (illustrative): "If you made this change, how would it affect your family? Who would you want to be part of deciding?"
  • Watch for:
    • Family involvement that silences the client, or exposes abuse or risk.
    • Check privately before any joint session.
    • Working when: the client brings family or Elders into the plan voluntarily.

4.10 Collaboration with Elders and Inuit counsellors

  • Purpose / when: When the client wishes, to bring Inuit knowledge and language into care. Examples include Elders in counselling roles, Elders-in-training initiatives that build healing skills in the middle generation, and Inuktut counsellors. [source: Inuusivut Anninaqtuq, 2-2 C, 2-2 E, 2-4 D] Evidence from other regions shows that structured collaboration with community healers can improve outcomes. In COSIMPO (Ghana and Nigeria), collaborative shared care with traditional and faith healers reduced psychosis symptoms more than usual care. [source: Gureje et al. 2020, PubMed 32861306 summary] This is context, not an Inuit model. [synthesis]
  • Steps:
    1. Get the client's explicit consent: who will be contacted, what will be shared and what will not.
    2. Contact through the service or community route the client names.
    3. Clarify roles. The Elder or Inuit counsellor brings cultural knowledge and teaching; you bring psychotherapy and risk management. Neither directs the other.
    4. Agree how you will communicate, and what happens if risk arises.
    5. Offer reciprocity and respect, following local custom on recognition or honoraria. The service or community sets this. [uncertain: not verified]
  • Example language (illustrative): "Would it help to have an Elder involved? If so, who would you want, and what would you be comfortable with me sharing?"
  • Watch for:
    • Do not ask an Elder to perform or arrange angakkuq practices.
    • Small-community confidentiality: the Elder may be related to the client.
    • Conflicting advice between you and the Elder. Discuss it with both, with the client present if they wish.

4.11 Referral to Inuit-led programmes

  • Purpose / when: For addictions, family healing, youth risk or cultural reconnection.
  • Steps:
    1. Match the need to a programme:
      • Isuarsivik: family-based recovery that combines Inuit values, time on the land and contemporary methods. It plans to house whole families and runs six-week sessions in its current programme. [source: Makivvik 2023]
      • Land-based youth and language-and-culture camps. [source: Inuusivut Anninaqtuq, 3-3]
      • Grief groups. [source: Inuusivut Anninaqtuq, 2-5]
    2. Make a warm handover with consent.
    3. Continue individual therapy alongside, if the client wishes.
  • Example language (illustrative): "There's a programme in Kuujjuaq where families heal together, with time on the land. Would you like to hear more?"
  • Watch for:
    • Wait times and travel costs.
    • A client feeling "sent away." Keep the door open.

4.12 Integrating cultural and healing experiences

  • Purpose / when: After the client has time with Elders, on the land, in church healing or in cultural programmes, so that meaning and change are consolidated.
  • Steps:
    1. Invite the client to share what they choose.
    2. Explore what was meaningful, and what was difficult or unsettling.
    3. Link insights to therapy goals.
    4. Note any re-traumatisation, for example when residential-school or settlement memories surface. Pace accordingly.
  • Example language (illustrative): "What stayed with you from your time out on the land with the Elders? Is there anything you'd like to bring into our work?"
  • Watch for:
    • Do not interpret the teachings or the spiritual meanings for the client.
    • Working when: the client describes renewed identity, relationships or hope in their own terms.

4.13 Trauma and grief work within the ITK frame

  • Purpose / when: For unresolved trauma and grief, including historical and intergenerational trauma. These form ITK priority area 5 ("Heal Unresolved Trauma and Grief"). [source: ITK NISPS, pp. 21, 29]
  • Steps:
    1. Use trauma-informed, culturally safe practice. [source: ITK NISPS, pp. 29, 32]
    2. Name colonial causes alongside individual events when the client does.
    3. Use evidence-based trauma therapies you are trained in, paced and adapted with the client.
    4. Connect the client to grief groups and community response teams where they exist. [source: Inuusivut Anninaqtuq, 2-5]
    5. Support cultural continuity, such as language, history and land, through Inuit-led routes. [source: ITK NISPS, priority 2]
  • Example language (illustrative): "Some of what you carry seems to come from what happened to your family and community, not just to you. Would it help to talk about that history too?"
  • Watch for:
    • Overwhelm when multiple losses are stacked.
    • Use grounding and slow the pace.
    • Avoid framing culture as a "tool" detached from its holders.

4.14 Suicide-risk assessment and safety planning

  • Purpose / when: At every contact where risk may be present. ITK names these risk factors: exposure to suicide, childhood adversity, mental distress, acute stress and access to lethal means. [source: ITK NISPS, pp. 14, 22–25]
  • Steps:
    1. Ask directly about suicidal thoughts, intent, plans and past attempts, using current standard practice.
    2. Build a safety plan with the client, and with family if the client agrees. The Nunavut Mental Health Act emphasises family's protective role and allows a tikkuaqtaujuq (representative) who may be notified of attempts. [source: Nunatsiaq 2021]
    3. Lethal-means counselling: agree with the household on safe storage or removal of firearms and medicines.
    4. Name crisis lines. The CBC names the Kamatsiaqtut Help Line in Nunavut. [source: CBC]
    5. Know the Act's provisions on earlier intervention, community assisted treatment orders and review. [source: Nunatsiaq 2021]
  • Example language (illustrative): "Sometimes when people feel this way, they think about ending their life. Have you been having thoughts like that?"
  • Watch for:
    • Non-interference norms that stop family from acting. Discuss these openly. [source: Wihak & Merali, p. 250]
    • Clusters after a death in the community.

4.15 Postvention

  • Purpose / when: After a suicide in the client's family or community.
  • Steps:
    1. Offer support to the bereaved.
    2. Link with community response teams, grief groups and the interagency crisis protocols for clusters set out in Inuusivut Anninaqtuq. [source: Inuusivut Anninaqtuq, 2-5, 2-7]
    3. Screen exposed young people for risk.
  • Example language (illustrative): "Many people in the community are hurting after this loss. How are you and your family doing, and who is around you right now?"
  • Watch for:
    • Contagion risk.
    • Your own vicarious distress.

4.16 Safeguarding

  • Purpose / when: When any practice, whether spiritual, religious or familial, involves abuse, coercion, neglect or delay of urgent care, or when a child is at risk. Childhood maltreatment "dramatically" raises suicide risk. [source: ITK NISPS, p. 22]
  • Steps:
    1. Separate cultural or spiritual meaning from harm. A practice framed as tradition does not justify abuse, and a cultural practice must not be misread as abuse.
    2. Consult an Inuit colleague or cultural broker.
    3. Follow the mandatory reporting law of your territory or province. Tell the client what you must report, where safe to do so.
  • Example language (illustrative): "I respect your family's ways. When a child might be getting hurt, though, I have a duty to make sure they're safe, and I'd like us to talk about how we do that together."
  • Watch for:
    • Fear of child-welfare involvement, given its historical role in Inuit family separation. [synthesis]

4.17 Work with children and youth

  • Purpose / when: ITK priority area 3 ("Nurture Healthy Inuit Children"). [source: ITK NISPS, p. 29]
  • Steps:
    1. Use the CFI School-Age Children and Adolescents module. [source: APA Supplementary Modules]
    2. Seek assent from the young person and consent from carers.
    3. Involve family in line with pijitsirniq.
    4. Link to Inuit-led youth and land programmes, and to Inuit childrearing programmes such as Inunnguiniq. [source: Inuusivut Anninaqtuq, 3-3 C; ITK resource listing; content of Inunnguiniq uncertain: not verified]
  • Example language (illustrative): "What do you like doing with your family or out on the land? Who's an adult you trust?"
  • Watch for:
    • Exposure to suicide in peers.
    • Abuse at home.
    • Loss of language and identity.

5. Handling problems

The sources give only general direction on these problems. Responses are [synthesis] unless a source is cited.

  • Client asks you to find or arrange an angakkuq.
    • Explain that this is not your role, and that knowledge and authority rest with Inuit Elders and communities.
    • Explore what the client hopes such help would bring.
    • Offer routes the community sanctions: Elders, Inuit counsellors, programmes.
    • Do not suggest outside "shamanic" practitioners.
    • Example (illustrative): "That's something that belongs to Inuit Elders and communities, not to me. Could we think together about who in your community you'd trust to talk with about it?"
  • Family conflict between Christian and traditional meanings. Stay neutral, and use the Spirituality, Religion and Moral Traditions module with each person. Look for shared goals, such as the young person's safety and family harmony. Elders describe a range of views, so do not frame either side as "more Inuit." [source: Anthropologica review, pp. 196–197]
  • Quiet, non-disclosing or "stuck" client.
    • Respect non-interference and observational learning. Do not interpret silence as resistance. [source: Wihak & Merali, pp. 249–250]
    • Slow down and offer choices.
    • Use activity-based or walking sessions where possible, and include a trusted person.
    • Careful self-disclosure can build alliance. [source: Wihak & Merali, p. 249]
  • Advice-giving expectations. Some clients may expect an Elder-like adviser, and others may resent direction. Ask which they prefer. Default to collaborative decision-making (aajiiqatigiinniq). [source: Wihak & Merali, p. 251]
  • Rupture over cultural misstep or perceived racism.
    • Name it and apologise specifically.
    • Ask what would repair it, and revisit CFI Q16, the clinician–patient relationship. [source: APA CFI]
    • Offer an Inuk co-worker or interpreter if available.
  • Overwhelm in trauma and grief work. Pause the exposure-based work, return to grounding and safety, and involve supports the client chooses. Check for compounded community losses.
  • Non-attendance. Consider travel, hunting season, funerals, family obligations (pijitsirniq), phone access and stigma before treating it as non-adherence. Offer flexible contact, and phone or video sessions.
  • Confidentiality in small communities. Agree how you will greet the client in public. Wihak and Merali note that acknowledging clients socially is expected [source: p. 248], so check the client's own preference. Be careful about which interpreter and Elder are involved.
  • Uncertainty about psychosis versus spiritual experience.
    • Hold both possibilities and consult a cultural broker (4.8).
    • Arrange medical and psychiatric assessment where there is risk, disorganisation or decline. Do not delay urgent care while awaiting cultural consultation.
  • Medication questions. Never advise starting, stopping or changing a medicine. Route these to the prescriber. If the client prefers cultural healing to medication, explore the reasons and share them with the prescriber, with consent.
  • Request to use, record or teach Inuit cultural knowledge. Do not reproduce Elders' teachings, songs or restricted knowledge in your materials. Use Inuit-published sources and credit them. Defer to Inuit organisations on cultural content.
  • Your own limits. If you are non-Inuit, seek supervision with Inuit cultural input, and support Inuit-led training such as Our Life's Journey rather than substituting for it. [source: ITK, Our Life's Journey; Inuusivut Anninaqtuq, 2-3]
  • Systemic barriers (housing, food insecurity, poverty). ITK places social equity first among its priorities. [source: ITK NISPS, pp. 17–19, 29] Advocate and link to services; do not individualise structural harm.

Sources

Books:

  • Laugrand, F. & Oosten, J. (eds) (2010). Inuit Shamanism and Christianity: Transitions and Transformations in the Twentieth Century. McGill-Queen's University Press. Cited via the Anthropologica review.
  • Saladin d'Anglure, B. (ed.) (2001). Cosmology and Shamanism (Interviewing Inuit Elders, vol. 4). Nunavut Arctic College. Cited via the publisher's page.
  • Kleinman, A., Eisenberg, L. & Good, B. (1978). Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88:251–258. Page range per Dinos et al. 2017 [uncertain].
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