A Summary of the Evidence on Suicide Presented to the Standing

Centre for Suicide Prevention A Summary of the Evidence on Suicide Presented to the Standing Senate Committee on Social Affairs, Science and Technology Compiled by: Centre for Suicide Prevention, a program of the Canadian Mental Health Association March 24, 2004 CANADIAN MENTAL HEALTH ASSOCIATION L’ASSOCIATION CANADIENNE POUR LA SANTÉ MENTALE “What we hope to do … will be to put together a fact base on the health care system in Canada with respect to mental health and mental illness.” Senator Kirby (Issue 9) “It (testimony) is people crying out for help and asking us to please do something. Hopefully, our report on mental health will be the starting point of something good happening.” Senator Cordy (Issue 15) “The more compelling the evidence I hear, the more convinced I am that there is a need for a national action plan for mental illness and wellness….The more I listen, the more I am convinced that would be the best way to go.” Senator Cook (Issue 14) “I hope our report might act as an instrument to tell the federal government that some sort of driving, national strategy is needed.” Senator Roche (Issue 15) “We have the knowledge and approaches and … with federal leadership significant things can be done …. there is much development in the area of mental health delivery. It is an important time for federal leadership in the area of mental health and, in particular, suicide prevention.” Dr. Paul Links (Issue 11) Evidence Summary on Suicide, Page 2 Compiled by the Centre for Suicide Prevention Table of Contents List of Witnesses Tabulation of Evidence on Suicide Section One: Background Information Incidence and Prevalence of Suicide Cost to Canadians Gender and Suicide Mental Illness and Suicide Youth and Suicide Aboriginals and Suicide Treatment Research/Evaluation Anecdotal Evidence Section Two: Recommendations For Action Recommendations Toward a National Suicide Prevention Strategy New Supplementary Information Supplied by the Centre for Suicide Prevention Listing of SIEC Alerts Available through the Centre for Suicide Prevention Suicide Among Canada’s Aboriginal Peoples – SIEC Alert 52 Substance Abuse in Combination with Other Mental Illnesses -- SIEC Alert 51 4 7 8 8 9 10 11 11 12 14 15 19 20 22 Evidence Summary on Suicide, Page 3 Compiled by the Centre for Suicide Prevention Issues Concerning Mental Illness and Mental Health Proceedings of the Standing Senate Committee on Social Affairs, Science and Technology List of Witnesses Presentations Dated February 26, 2003 – June 12, 2003 Witness Issue 9 David Ronald Murray Loïse Affiliation Private Citizen Private Citizen Private Citizen Private Citizen Consultant, Canadian Institute for Health Information Vice-President, Research and Analysis, Canadian Institute for Health Information Assistant Director, Health Statistics Division, Statistics Canada Consultant, Private Citizen Professor and Head, Department of Psychiatry, Queen’s University Chief Privacy Officer and Manager, Privacy Secretariat, Canadian Institute for Health Information Senior Advisor, Mental Health, Healthy Community Division, Population and Public Health, Health Canada Past President, Canadian Academy of Psychiatric Epidemiology Arthur Sommer Rotenberg Chair in Suicide Studies, University of Toronto, St. Michael’s Hospital Associate Director, Division of Childhood and Adolescence, Centre for Healthy Human Development, Health Canada Professor and Head, Division of Child Psychiatry, Department of Psychiatry, University of Toronto; Psychiatrist-in-Chief, Hospital for Sick Children Child and Adolescent Psychiatrist Young Investigator, Canadian Institutes of Health Research, Centre hospitalier universitaire Mère-enfant Sainte-Justine Assistant Professor, Mental Health Evaluation and Community Consultation Unit, Department of Psychiatry, Faculty of Medicine, University of British Columbia Professor, Psychiatry Department, McGill University; Director, Eating Disorders Program, Douglas Hospital Chief of Psychiatry, Children’s Hospital of Eastern Ontario President-Elect, Canadian Paediatric Society Issue 11 Ms. Carolyn Pullen Dr. John S. Millar Ms. Lorna Bailie Mr. Thomas Stephens Dr. Julio Arboleda-Florèz Ms. Joan Roch Mr. Tom Lips Dr. Alain Lesage Dr. Paul Links Issue 13 Ms. Pam Massad Dr. Joe Beitchman Dr. Johanne Renaud Dr.Charlotte Waddell Dr. Howard Steiger Dr. Simon Davidson Dr. Diane Sacks Evidence Summary on Suicide, Page 4 Compiled by the Centre for Suicide Prevention Issue 14 Dr. Michel Maziade Dr. Rémi Quirion Head, Department of Psychiatry, Faculty of Medicine, Laval University Scientific Director, Institute of Neurosciences, Mental Health and Addiction, Canadian Institutes of Health Research Dr. Laurent Mottron Researcher, Department of Psychiatry, Faculty of Medicine, University of Montreal Dr. Richard Tremblay Canada Research Chair in Child Development, Professor of Pediatrics, Psychiatry and Psychology, Director of the Centre of Excellence for Early Childhood Development, University of Montreal Mr. Henri Dorvil Professor, School of Social Work, University of Quebec in Montreal Mr. Michel Tousignant Professor and Researcher, Centre de recherché et intervention sure le suicide et l’euthanasie Mr. Eric Latimer Health Economist, Douglas Hospital Dr. Mimi Israël Head, Associate Professor, Department of Psychiatry, McGill University Dr. James Farquhar Psychiatrist, Douglas Hospital Dr. Pierre Lalonde Director, Clinique Jeunes Adultes de l’Hôpital Louis-H. Lafontaine Mr. Jean-Jacques Leclerc Director, Rehabilitation Services and Community Living, l’Hôpital Louis-H. Lafontaine Dr. Renée Roy Assistant Clinical Professor, Department of Psychiatry, Faculty of Medicine, Université de Montréal Dr. Jean Wilkins Full Professor and Pediatrician, Department of Pediatrics, Faculty of Medicine, University of Montreal Mr. Jacques Hendlisz Director General, Douglas Hospital Ms. Robyne Kershaw-Bellemare Director of Nursing Services, Douglas Hospital Ms. Myra Piat Researcher, Douglas Hospital Ms. Amparo Garcia Clinical-Administrative Chief, Adult Ultraspecialized Services Division, Douglas Hospital Ms. Manon Desjardins Clinical Administration Chief, Adult Ultra Specialized Services Division, Douglas Hospital Issue 15 Mr. Patrick Storey Ms. Heather Stuart Ms. Jennifer Chambers Chair, Minister’s Advisory Council on Mental Health, Province of British Columbia Associate Professor, Community Health and Epidemiology, Queen’s University Empowerment Council Coordinator, Centre for Addiction and Mental Health Head, Department of Clinical Health Psychology, Faculty of Medicine, University of Manitoba Board Member, Institute of Aboriginal Peoples’ Health, Canadian Institutes of Health Research Mental Health Consultant, Private Citizen Director, Public Education and Information Services, Centre for Addiction and Mental Health Clinical Director, Addiction Medicine, Centre for Addiction and Mental Health, University of Toronto Professor and Head, Department of Psychiatry, University of Calgary Professor and Director, Rural and Northern Psychology Programme, University of Manitoba President, Registered Psychiatric Nurses of Canada Issue 16 Mr. John Arnett Ms. Bronwyn Shoush Ms. Nancy Hall Ms. Rena Sheffer Dr. David Marsh Dr. Donald Addington Mr. Robert McIlwraith Ms. Margaret Synyshyn Evidence Summary on Suicide, Page 5 Compiled by the Centre for Suicide Prevention Issue 17 Dr. David K. Conn Mr. Steve Rudin Ms. Maggie Gibson Ms. Venera Bruto Mr. J. Michael Grass Dr. Dominique Bourget Mr. Tim D. Aubry Dr. Jeffrey Turnbull Co-Chair, President, Canadian Academy of Geriatric Psychiatry, Canadian Coalition for Seniors Mental Health Executive Director, Alzheimer Society of Canada Psychologist, St. Joseph’s Health Care London Psychologist, Hamilton Health Sciences Centre Past-Chair, Champlain District Mental Health Implementation Task Force, Private Citizen President, Canadian Academy of Psychiatry and the Law Associate Professor, Co-Director, Centre for Research and Community Services, University of Ottawa Chairman, Department of Medicine, Faculty of medicine, University of Ottawa President, Advisory Board, Institute of Population and Public Health, Canadian Institutes of Health Research President and Chief Executive Officer, Warren Shepell Consultants, Global Business and Economic Roundtable on Addiction and Mental Health Director, CN Centre for Occupational Health and Safety Director of Programs, Canadian Mental Health Association, Ontario Division Issue 18 Mr. Jean-Yves Savoie Mr. Rod Phillips Mr. Kevin Kelloway Ms. Patti Bregman Evidence Summary on Suicide, Page 6 Compiled by the Centre for Suicide Prevention Tabulation of Evidence on Suicide Presented to the Standing Senate Committee on Social Affairs, Science and Technology Presentations Dated February 26, 2003 – June 12, 2003 Section One: Background Information Information Category Incidence and Prevalence of Suicide Issue Number 11 Details of Information Dr. Links – Over 4,000 Canadians per year die by suicide It is estimated that people who make suicide attempts may be at a risk 100 times greater than the general population Ms. Bailie According to Vital Stats, 3,700 Canadians took their own lives in 1998. That was an average of 10 per day. Between 1993 and 1998, suicide claimed more lives than motor vehicle accidents. 1998 – suicide was the leading cause of death for men aged 25-29 and 40-44. It was the leading cause of death for women age 30-34. Crude suicide rate for men was 22.6/100,000, which is much higher than the rate for women, at 5.8. Age-specific hospitalization rates by sex for suicide attempts – female is 103.9/100,000, much higher than the 69.2/100,00 for men. Females are at greater risk for (suicide) attempts. According to 1998 data, 1 in 10 persons who are hospitalized for a suicide attempt had been hospitalized for previous attempts. This creates a burden on the health care system. Question (Senator Cordy) I am just looking at the statistics you provided on the high percentage of people who attempt suicide and the number of deaths by suicide. I wonder whether or not this actually registers with the public. I know that the information is out there; we have certainly heard it as a committee and anybody involved with children certainly is aware of it. Is the public not willing to talk about and accept that the percentage is that high, or is the information just not reaching the public? 14 Evidence Summary on Suicide, Page 7 Compiled by the Centre for Suicide Prevention Answer (Mr. Tousignant) It is difficult to say how much the public knows…Perhaps they are not aware of the figure for suicide attempts because most of the statistics reported in the press are about suicide. There is much less information on suicide attempts. For each suicide, there are 10 suicide attempts hospitalized. There are many more attempts that do not come under professional supervision. The numbers are high. What the public does not see is the extent of moral suffering. Ms. Hall In B.C., a person a day commits suicide. Mr. Arnett 2% of all deaths in Canada annually are due to suicide. 2% may not sound like a lot, until you see that 16% of all deaths in those aged 25-44 are from suicide; 25% of all deaths of those aged 15-24 are from suicide. No one in this room would be concerned about it, but males aged 65 and older are also at significantly increased risk of suicide. Mr. Stephens Health Canada’s estimate currently of the cost of mental disorders is $7.9 billion annually. The estimate I made several years ago was $14.4 billion, almost double. On the basis of what Health Canada has just published, I would revise my estimate a little – in the neighbourhood of $14 billion. Mr. Tousignant Suicide attempts represent a very heavy cost in terms of hospital care. There are 500,000 hospitalized cases in the US and there must be 50,000 in Canada. That represents $10,000/person. Dr. Links There is a four-to-one ratio, men to women, in suicide deaths There is a four-to-one ratio, women to men, in suicide attempts Mr. Lips Suicide is the leading cause of death among Canadian males ages 10 to 49. Dr. Conn It is important to note that the instance of suicide among men 80 years of age and older is the highest of all age groups in Canada. Regarding suicide…it seems as though men, when they get very depressed, often do not seek out help. They do not talk to anyone. They find it harder to admit that they have a psychological problem. Moreover, when men become suicidal, they tend to choose more lethal approaches to a suicide attempt. Thus, they are more likely to choose hanging or a weapon of some kind, whereas women are more likely to take an overdose 16 Cost to Canadians 11 14 Gender and Suicide 11 14 17 Evidence Summary on Suicide, Page 8 Compiled by the Centre for Suicide Prevention Mental Illness and Suicide 11 Dr. Links 9 out of ten people who die by suicide are suffering from mental illness at the time they die Dr. Arboleda-Florèz We already know of the relationship between depression and suicide. We know….there is much more depression and suicide among impoverished groups and in Aboriginal groups. Mr. Lips It (poor mental health) is manifested in hopelessness, anxiety, school failure, lack of self-care, excessive risktaking, lack of productivity, family breakdown, substance abuse, antisocial behaviour and, in the extreme, self-injury, suicide and violence. Dr. Renaud Among the risk factors, the presence of one or more mental illnesses can be found in 90 per cent of deaths by suicide. Dr. Maziade Schizophrenia and manic-depressive psychosis alone affect over a million Canadians. Some people are hit with these illnesses by the age of 20. Ten percent die by suicide when they are still young and others are affected for the rest of their lives. Another 2 percent of the population suffers from recurring major depression and 8 percent suffer from major depression their entire life. Mr. Storey Recent research in B.C. has found that people with mental illness who have had one hospitalization have a mortality rate seven times greater than that of the general population (research by Dr. Eliot Goldner) 13 14 15 Evidence Summary on Suicide, Page 9 Compiled by the Centre for Suicide Prevention Youth and Suicide 13 Dr. Beitchman Children with mood disorders, anxiety disorders and suicide tendencies often suffer in silence; they are an invisible minority. These are quite prevalent at approximately 9 per cent to 13 per cent of the population. Furthermore, children and adolescents with mood and anxiety disorders are at increased risk for suicide. More teenagers and young adults die of suicide than die from cancer, heart disease, AIDS, pneumonia, influenza, birth defects and stroke combined. More than 90 per cent of children and adolescents who (die by) suicide have a mental disorder. Suicide attempts peak during mid-adolescence and the mortality from suicide increases steadily through the teen years. Dr. Renaud In 1997, 312 young people died as a result of suicide in Canada – 261 between 15-19 years of age and 51 who were 14 or younger…. Suicide among young Canadians is a serious problem that should be made a priority. Some groups of young people seem particularly at high risk of suicide and suicidal behaviour, notably young people who receive services from youth centers under the Young Offenders Act or child protective services, young people who come from families with a history of suicide or suicidal behaviour, as well as young Aboriginals. Dr. Sacks There is one more thing about depression that you need to know. Depression is the leading precipitating factor associated with suicide. Some say that suicide is the second most common cause of adolescent mortality in Canada, after motor vehicle accidents. It is a statistic that puts Canada among the First World countries with the highest teen suicide rates, even higher than the U.S. I say that some say it is the second most common cause because, after years of working with adolescents, I know that some depressed teens get drunk, get into a car and kill themselves, and that is recorded as an MVA, not as a suicide. Question (Senator Kinsella) It seems to me that one of the most horrific examples of failure in the child mental health delivery model occurs when we have a child suicide…. Is there not much to be inferred from keeping quiet about the real numbers of teenage or child suicide? For example, what are the real numbers in Canada? Answer (Dr. Davidson) About 12-13/100,000, for males and females. This is 15 to 19-year-olds. It would be lower if we included 0-14. Question (Senator Kinsella) Do you agree that we need to shine the light on suicide, which is a failure on society’s part, and in so doing, put the light on the state of the mental health delivery system in Canada, because here is a real example of where it is Evidence Summary on Suicide, Page 10 Compiled by the Centre for Suicide Prevention broken? Answer (Dr. Sacks) That is the total life lost….We cannot do it on an individual case basis because copycat suicide do exist and we must be careful about that. There is no reason, however, why we should not, as child advocates, make it known that children can become so desperate that this is the only recourse open to them….people do not recognize that this problem truly exists in Canada. …70% of teenagers who committed suicide saw a physician within a month previously. They (physicians) may not have been trained properly. And/or, current health and other funding for psychologists/social workers to see these kids is not present. Toronto – mental health beds for teens have closed. Rural areas – no mental health support in hospitals. Dr. Millar Some evidence exists that the preservation of culture, selfgovernment and self-determination may eliminate or prevent youth suicide in certain groups. Dr. Lesage Research results showed that the treatment of depression in Scandinavian countries… was associated with a drop in the suicide rate. In Sweden, for example, we are talking about a drop of 25 per cent over a ten-year period. That is highly significant in a country like Sweden. What that means is that Sweden will have 400 to 500 fewer deaths by suicide every year. While taking action to treat depression – which deals with one of the causes of suicide – is important, we mustn’t forget other kinds of action that are necessary. Dr. Links We have evidence that there are promising interventions that can actually prevent the risk of further suicide behaviour…. We can demonstrate that we can prevent subsequent suicidal behaviour. There is evidence that medication can affect the risk of suicide. It (Clozapine) has been demonstrated to reduce the risk of suicidal behaviour by 26 per cent in a carefully conceived study. Mr. Lips …prevention and promotion are more challenging and difficult to grasp because they are dealing with long timelines…. We probably will never have the degree of evidence for a psychosocial intervention that we can have for a medication….There is a vast body of literature that supports these kinds of interventions. There is a point at which we must look at both the high-tech and low-tech interventions in mental health. Question (Senator Keon) …what could be done at the federal level to make a significant impact on this horrific problem of access to care in the area of mental illness and mental disease? Aboriginals and Suicide 11 Treatment 11 Evidence Summary on Suicide, Page 11 Compiled by the Centre for Suicide Prevention 13 Answer (Dr. Links) As we have heard from Dr. Lesage stigma is a huge problem. As we know, people do not come forward for treatment of mental illness, substance abuse and suicide because of the stigma associated with them. It is a complex problem. Part of tackling stigma is to provide the knowledge and evidence that things can be done to correct the problem. Dr. Renaud Lack of consensus among service providers on the general intervention framework, absence of concerted effort and ongoing intervention among the resources of medical, psychosocial and community services are all major obstacles to achieving success with interventions designed for young people who present a high risk for suicide. Question (Senator Pépin) Today, people are saying, and I believe it, that many homeless people have mental health problems….. Do you think that there is a fairly high number of young delinquents with psychiatric problems who have not received any treatment? Answer (Dr. Renaud) We researched the files of social services and found that approximately one third of young people under the age of 19 who (died by) suicide had been in the care of or were in the care of social services when they (died by) suicide. Fifty percent of them were receiving services when they (died by) suicide….These young people are between five and ten times more at risk than the average young person. Mr. Hendlisz The stigma of mental illness or mental breakdown … is probably the greatest barrier to seeking and receiving care. Ms. Bregman In Ottawa for example, there is a 5-year waiting list for case management services for people with serious mental illnesses. Half the people on that waiting list have attempted suicide. Dr. Millar We cannot manage the system, including the mental health component, and create effective services without better information. Dr. Arboleda-Florèz Although we are now benefiting from the work done by Statistics Canada, we already heard that it does not study our Aboriginal or homeless population. Most of the mental health populations are homeless. That is a major drawback to the data…. 14 18 Research/Evaluation 11 Evidence Summary on Suicide, Page 12 Compiled by the Centre for Suicide Prevention 13 Dr. Renaud Our understanding of suicide is based on biological, psychological and sociological theories. But each one of these theories taken individually does not explain the multiple facets of this problem…. Suicide is and always has been a complex phenomenon. As far as research is concerned, we should focus on biopsychosocial research and study suicide deaths in young people throughout Canada to improve our understanding of the way biological, genetic and psychosocial factors are interrelated. There is another element that is a necessary part of any broad, comprehensive population approach to any sort of health problem …. That involves the need to monitor outcomes. There is not yet monitoring …. To ascertain whether the services and interventions we are providing are reducing the number of children affected and the impairments associated with disorders. Outcome monitoring needs to include broad population-health indicators, eg. school completion, child protection and justice system involvement, and suicide rates. It also needs to include epidemiological surveys of incidence and prevalence of disorders. Dr. Quirion Research in mental health and mental illnesses is underfunded in Canada compared with the costs to society. In 1998, the estimate was 14 billion dollars per year. It is likely to be higher today post-September 11, following the stress of the recent war and all of these things. CIHR provides approx. $40 million per year for mental illnesses and addictions. Mr. Tousignant Mental health is often not sufficiently funded in relation to the costs and burden these types of illnesses represent for society. With regard to suicide, which is the principal cause of death for men under 40 in Canada, there is a lack of funding compared to other causes of death such as heart disease or cancer. Steps that need to be undertaken are more and more onerous and the results are more and more restricted. Eg, – to gain access to families of those who have committed suicide, we can no longer contact these families directly – we have to send a letter via the chief coroner. If the family respond to this letter, we can conduct the research. That means we often get a 30 or 40/100 response rate, which to some extent calls into question or invalidates the representative nature of these populations. Ms. Shoush Privacy legislation puts up many kinds of barriers to better health. It also puts up barriers to research that might allow us to come up with better strategies for mental health supports for persons needing them. 14 16 Evidence Summary on Suicide, Page 13 Compiled by the Centre for Suicide Prevention Anecdotal Evidence 9 David My son is 31 years old….My son is classically autistic…He could not sleep, so he would keep us awake all through the night. We would be awake trying to sedate him, to make him relax. The medication sometimes did not work. He would become suicidal. He would scream out, ‘Why don’t you kill me? I want to die.’…We got a phone call from the teacher saying, ‘Your son is threatening to commit suicide. On the transatlantic flight, he was screaming and yes, and now he is saying that he wants to commit suicide. He will commit suicide. You have to come and get him.’ Ronald My wife has schizophrenia… She was hospitalized for 3 months and attempted suicide a number of times. Someone stayed in her room 24 hours a day for three months to prevent her from committing suicide. Mr. Story I am also the parent of a son who has struggled with depression and suicide. He spent four hours in handcuffs at our local emergency ward following a suicidal gesture. 14 Evidence Summary on Suicide, Page 14 Compiled by the Centre for Suicide Prevention Tabulation of Evidence on Suicide Presented to the Standing Senate Committee on Social Affairs, Science and Technology Presentations Dated February 26, 2003 – June 12, 2003 Section Two: Recommendations For Action Recommendations Toward A National Suicide Prevention Strategy 11 Dr. Links My central message is that in the area of mental illness and mental health we have the knowledge and approaches and that with federal leadership significant things can be done. Most developed nations around the world now have suicide prevention strategies. Question (Senator Morin) Is Canada on the list? Answer (Dr. Links) No. The irony is that all suicide prevention strategies came out of a group in Alberta that developed the framework for suicide prevention. We have the knowledge and the ability, but have not developed the strategies. Some aspects of a national strategy that are available to us – 1. health promotion 2. combating stigma 3. preventing access to means (eg, barrier to Bloor Viaduct). In the United States, the plan is that everyone in the nation will have some knowledge of suicide prevention the same way we have knowledge about cardiorespiratory intervention for someone who has a heart attack. (In Canada) we have universal health care for treatment, which is very important. We have an excellent surveillance system (Stats Canada) that can be built upon. The Canadian Institutes of Health Research has recently adopted a focus on new suicide research, which is a very promising initiative. There is much development in the area of mental health delivery. It is an important time for federal leadership in the area of mental health and, in particular, suicide prevention. Canada has an active suicide prevention approach. Suicide prevention has a long tradition of working at the community level. The Canadian Association for Suicide Prevention has much leadership in this area. At the ground level, we are set. Evidence Summary on Suicide, Page 15 Compiled by the Centre for Suicide Prevention We are at a stage where national leadership can have a true impact. Question (Senator LeBreton) You talk about the national prevention efforts in Norway, Sweden, New Zealand, et cetera. Do you have data to show the success rates of these programs in those countries? Answer (Dr. Links) Finland program has been most closely evaluated. The indication is that at the beginning of the program they experienced a 20 per cent reduction in suicide rate; it has now leveled off at a 10 per cent reduction. That is the most significantly evaluated program. In the coming years we will hear from other settings, including the U.K. and Australia. Question (Senator Callbeck) Dr. Links, you mentioned the national strategy for suicide prevention. Is it too early to tell whether that strategy has been effective? Answer (Dr. Links) The Finland national strategy indicates that they were able to achieve lower rates of suicide. There is no such strategy in Canada. Question (Senator Cordy) Dr. Links we have spoken about the accountability of health care and the need for targeted funding. Will you be looking at targeted funding for health care initiatives? Answer (Dr. Links) A particular accountability marker could be the reduction in suicide rates. Certainly, nations that have undertaken a mental illness or suicide prevention health strategy have a set specific suicide target rates as an indicator of effectiveness. Question (Senator Morin) We know just how hard it is to demonstrate the effectiveness of preventive measures….Dr. Links, I am struck by the fact that we do not have a national suicide program of suicide prevention…..Do you think we should have a national suicide prevention program? If you do, do you believe it should be an official initiative? Answer (Dr. Links) It is true that we need to know more, but I think we know enough to proceed. There are primary prevention initiatives in the area of suicide prevention that are quite robust in terms of their proof. One of the most promising initiatives deals with access to means, such as gun legislation. Examples: • • • Evidence Summary on Suicide, Page 16 Compiled by the Centre for Suicide Prevention gun legislation (Canada) restricting coal gases (U.K.) Restricted packaging of acetaminophen (U.K.) • changes to exhaust from car fumes (potential) These are primary prevention initiatives. Another one that seems to be in that realm is media intervention….Some of those clearly require a federal initiative. Secondary prevention: early identification of people at risk…All the family physicians on Gotland were trained in the recognition of and intervention for depression. There was a drop in the suicide rate subsequent to this intervention…. There is evidence that if you teach gatekeepers to more readily identify depression and intervene, there can be an impact. Tertiary prevention: We take people at high risk that have recurrent suicide behaviour. We can now develop interventions that can prevent them from repeating that behaviour and suicide. There is a need for timely federal leadership in this area. The U.S. is a good example. We know enough to put in place a preventive strategy that could have an impact on reducing the rates. The Canadian leadership formulated these kinds of strategies that could be put in place. We have the knowledge. Unfortunately, Canada has a higher suicide rate than the United States. We could be shamed into taking action. In the area of suicide prevention the time is right. We need national leadership on it. Question (Senator Morin) Should Health Canada or a professional organization initiate the program? Answer (Dr. Links) There must be federal government leadership. The most successful national strategies have had federal government leadership. It must be translated to each and every community because the community initiatives need to be different according to their situations (eg, geography, culture). Most national strategies have set targets and work toward a specific goal that can be measured and to which people can be accountable. Some of these issues would very much come from a federal initiative. Research comes from federal funds. Access to means, health promotion could both be led federally. Evidence Summary on Suicide, Page 17 Compiled by the Centre for Suicide Prevention 13 Dr. Renaud 1. According to the World Health Organization, the primary suicide prevention strategy necessarily involves treatment of mental illness. 2. Make screening and early treatment of mental illness among children and adolescents a priority, especially those with a family history of suicide. 3. Raise awareness among various network stakeholders, and provide them with information and training in accordance with their roles and responsibilities 4. Train general practitioners in the evaluation and treatment of major depression among the young 5. Establish a network of coordinated treatment and services In terms of prevention within our schools, we suggest replacing programs dealing specifically with suicide with activities that promote mental health. It should be noted that the effectiveness of suicide prevention telephone lines and advertising campaigns focusing directly on suicide has yet to be proven from a scientific standpoint….Instead, we should focus on mental health promotion campaigns…. Both clinical and scientific data support the concept whereby the diagnosis and medical treatment of depression should be viewed as essential components in any suicide prevention strategy, highlighting once again the role of medical teams in the community and the importance of their training. Dr. Quirion We will be undertaking national strategies on tobacco abuse and nicotine reduction, suicide, neurogenetics, gambling and addiction. We have our work set out over the coming years. 2 recommendations for national action: 1. Increase funding for neurosciences, mental health and addiction research in Canada 2. National action plan for research in the field for this country 14 Evidence Summary on Suicide, Page 18 Compiled by the Centre for Suicide Prevention Centre for Suicide Prevention SIEC Alert Listing What is a SIEC Alert? SIEC Alert is a publication developed and distributed by the Centre for Suicide Prevention. Published four times each year, SIEC Alert is a topical review of the literature, on an issue or area related to suicide. What are Some of the SIEC Alert Topical Reviews Currently Available? Visit the Centre for Suicide Prevention website, where the following previous editions of SIEC Alert are available for download: Alert 53 (December 2003) Alert 52 (September 2003) Alert 51 (May 2003) Alert 50 (November 2002) Alert 49 (September 2002) Alert 48 (May 2002) Alert 47 (February 2002) Alert 46 (November 2001) Alert 45 (July 2001) Alert 44 (April 2001) Alert 43 (January 2001) Alert 42 (October 2000) Alert 41 (July 2000) Alert 40 (April 2000) Alert 39 (January 2000) Alert 38 (December 1999) Alert 37 (September 1999) Alert 36 (July 1999) Alert 35 (May 1999) Alert 34 (March 1999) Alert 32 (October 1998) Alert 31 (August 1998) Alert 30 (June 1998) Alert 29 (April 1998) Alert 28 (February 1998) Alert 27 (December 1997) Alert 22 (February 1997) Alert 16 (December 1995) Suicide Among Gay, Lesbian, Bisexual or Transgendered Youth Suicide Among Canada’s Aboriginal Peoples Substance Abuse in Combination With Other Mental Illnesses Rural Stress No Suicide Contracts: Findings from Research Homicide Followed by Suicide? Childhood Abuse and Suicidal Behaviours Grief After Suicide: Qualitative Differences A Suicide Attempt is Meaningful and Significant Bereavement in the Workplace A Closer Look at Self-Harm Stress in the Workplace AIM to Prevent Suicide Suicide Prevention Doesn’t Always Mean Talking Children and Suicide Supporting Suicide Survivors Music and Suicide The Challenge of Suicide Clusters Barriers to Help-Seeking Suicide By Cop Considerations for School Suicide Prevention Depression: Some Pieces of the Puzzle Trends in Canadian Suicide Inmate Suicide Suicide Among the Aged When Gambling Becomes a Problem Telling Children About Suicide Are Suicide Rates Higher at Christmas? Can I become a SIEC Alert Subscriber? Yes, you can. SIEC Alert subscribers receive their quarterly publications either by mail or by e-mail. To subscribe, please e-mail your request to gayle@suicideinfo.ca. This is a free service. Alternatively, you can visit the www.suicideinfo.ca website and download current and prior editions of SIEC Alert. Evidence Summary on Suicide, Page 19 Compiled by the Centre for Suicide Prevention