Breaking the silence: A call for a national suicide prevention strategy

CrossCurrents

By Antoon A. Leenaars

Suicide is a major public health problem. Almost 4,000 Canadians take their own lives every year. Youth suicide rates have risen in the last 40 years. Suicide is at epidemic levels in some First Nations and Inuit communities. Quebec is especially inflicted. Suicide is destructive to families and other survivors. But it can be prevented. The federal government, together with provincial and territorial governments,must make suicide prevention a health priority.

In the 1970s, Health Minister Marc Lalonde commissioned a study of public health problems that identified suicide as a major cause of early death, especially among youth. This was a surprise to most Canadians, including government. Yet the subject was – and remains – taboo. The federal government did little – and continues to do little. But many of us – professionals, survivors and the public – are breaking the silence.

Suicide is the result of an interplay of individual, relationship, social, cultural and environmental factors. The complexity of suicide dictates the necessity of a parallel complexity of solutions. There will never be the solution. We need not only a mental health approach that targets individuals but also a public health approach.

Sociologist Emile Durkheim, over 100 years ago, suggested such a public health approach to suicide prevention. It defines, describes and measures the problem. It studies probable causes and how to predict and control the problem. Once we have determined that a tactic works, a public health approach implements a strategy within the broader population and evaluates outcomes. It is interdisciplinary and science-based. It emphasizes collective action.Most important, it has been proven to be effective.

The public health approach is an innovative, rational and organized way to marshal prevention efforts that is espoused by the World Health Organization (who). This is not to say that individual-based approaches such as psychotherapy or pharmacotherapy are not effective, but that public health approaches address the problem in a different way. Diverse suicide prevention strategies are necessary to not only solve what is sometimes assumed to be primarily a “medical problem,” but also to address taboo and stigma and to target specific groups, such as First Nations and Inuit peoples.

Many strategies and programs have been proposed – gun control, education programs in schools, joint efforts with the media to improve reporting, traditional community healing, crisis centres, postvention efforts with survivors. But from a public health perspective, these efforts are not comprehensive enough. Often, they have been established in isolation from large-scale approaches. It is difficult to show that such isolated approaches affect the national suicide mortality rate (although studies of gun control in Canada have done so).

We need a comprehensive, integrative approach. We need a national strategy that calls for promoting, co-ordinating and supporting activities that are sensitive to all peoples, not only First Nations and Inuit, but especially to them. The rate of suicide in some communities warrants such specificity.

Like many earlier publications, the 2006 Kirby report, Out of the Shadows at Last, calls for federal, provincial and territorial governments to work with stakeholders to develop a truly Canadian suicide prevention strategy. Maximizing the effectiveness of such a strategy requires a solid foundation supporting strategy development and delivery. Research, training and information dissemination are essential structural supports. Collaboration across a broad spectrum of people will be necessary for more effective awareness, training and research. The who has identified collaboration as key.

There will be obstacles, but the benefits of a national strategy for suicide prevention will be numerous. A national strategy raises awareness; makes suicide prevention a national priority; supports collaboration across a broad spectrum of governments, agencies, institutions, groups and people; brings together multiple disciplines and perspectives; sets priorities with finite resources; maximizes success (it is evidence-based); and can be integrated into mental health, public health and social policies.

Guidelines exist to help develop a strong national strategy. In 1996, the who developed preliminary international guidelines. The Canadian Association for Suicide Prevention’s 2004 Blueprint for a Canadian National Suicide Prevention Strategy offers a beginning. Australia, England, Finland, Ireland, New Zealand, Norway, Sweden and the United States have developed national strategies that can guide us. For example, the national suicide prevention strategy for England exemplifies evidence-based practices. It outlines six goals: (1) to reduce risk in key high-risk groups, (2) to promote mental well-being in the larger population, (3) to reduce the availability and lethality of suicide methods, (4) to improve media reporting of suicide, (5) to promote research on suicide and suicide prevention and (6) to improve monitoring progress toward the Saving Lives: Our Healthier Nation (a larger national policy on health) target for reducing suicide.

The aim of our national strategy would be not only to reduce suicide but also to co-ordinate activities and evaluate as new priorities and evidence emerge. The strategy should be a creative, coherent and truly national approach that is comprehensive, evidence-based, specific and subject to evaluation. There will be challenges: The “do nothing” approach since Lalonde in the 70s has been a major problem. We will need co-operation among all levels of government; integration; funding; a framework for core training, specifically responsive to local and national cultures; research; a general health/public health policy and public awareness and involvement.

Suicide can be understood, predicted and controlled. It is not inevitable. We can do much to prevent it. But prevention is not the exclusive responsibility of researchers or health providers or survivors. We need to work together to break the silence. One big question remains:Will Canadian governments finally do so?

Dr. Antoon A. Leenaars is the first past president of the Canadian Association for Suicide Prevention and a past president of the American Association of Suicidology.