Canada's 'public health crisis' of suicides needs funded prevention plan: CMAJ editorial

Canada needs a national suicide prevention strategy with concerted federal funds, medical journal editors say.

In 21 developed countries with government-led prevention programs, suicide rates declined, especially in young people and older individuals, Laura Eggertson and Dr. Kirsten Patrick said in an editorial published in Tuesday's Canadian Medical Association Journal.

Yet in Canada, suicide is the second leading cause of death among those aged 15 to 34, after motor vehicle accidents.

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Rates for Indigenous populations are staggeringly high.

In Nunatsiavut in northern Labrador, suicide rates are 25 times the national average. In Nunavut, rates are 10 times the national average.

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The CMAJ's call for a concerted plan comes ahead of Saturday's World Suicide Prevention Day by the International Association for Suicide Prevention, with the World Health Organization as co-sponsor. 

Canada remains the only developed country without a suicide prevention strategy with concerted funds, goals and commitment to reducing the rates of suicide, according to the Canadian Association for Suicide Prevention.

"News of clusters of suicides in Kuujjuaq, Que., Woodstock, Ont., and the Neskantaga First Nation may leave most Canadians feeling helpless before what seems an intractable problem," the CMAJ editorial reads.

But the national Inuit political association, Inuit Tapiirit Kanatami (ITK), has developed an evidence-based suicide prevention strategy. The rest of the country needs one too, Eggertson and Patrick say.

ITK's leaders know evidence shows suicide is preventable and that high rates can be reduced.

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Joanasie Akumalik's son hanged himself in 2013 when he was barely into his 20s. When a coroner's inquest was called in Iqaluit in the wake of a cluster of suicides that year, Akumalik shared his story.

Akumalik likes the idea of a Canada-wide strategy. "It would allow us to communicate across Canada to see exactly what kind of problems there are and how to identify prevention strategies."

Quebec strategy cuts suicide rates 

Since Quebec published its own prevention strategy in 1998, the province has cut suicide rates among those 15 to 19 in half and overall suicide rates by a third. Quebec's Indigenous populations opted out of the strategy and their suicide rates did not decline.

Quebec's strategy includes outreach through a crisis line and extensive patient followup.

"Substantial evidence exists to guide the creation of a strong suicide prevention strategy in Canada," the editorial reads. "It is noteworthy that the incumbent government, when in opposition, called for such a strategy," it says, referring to the current Liberal government.

Suicide prevention extends beyond mental health, the editorial says. It includes identifying children at risk of or suffering from sexual and physical abuse early, and intervening with culturally appropriate programs, such as in school. The education, justice, employment and social welfare sectors all need to be involved, it adds. 

The WHO has also urged countries to develop national strategies to address this preventable cause of death.

Among members of the Organization for Economic Co-operation and Development (OECD) that implemented government-led national strategies by 2011, suicide rates also declined among older people — another demographic group considered at greatest risk of Canada.

"The 2017 budget must pledge the means to developing a national suicide prevention strategy, starting with funds to create a centre of expertise that will engage with leading Indigenous organizations, such as ITK and the Assembly of First Nations, and build on existing strategies such as Quebec's, to address the needs of communities and plan the broader infrastructure that is required to address properly what has become a national public health crisis."

Properly funded, a national strategy could save lives, said Dr. Brian Mishara, director of the Centre for Research and Intervention on Suicide and Euthanasia at Université​ du Quebec à Montré​al.

"The report in 1987 and the second report on suicide in Canada in 1994 said it was urgent to do this immediately," Mishara said.

The Public Health Agency of Canada is developing a federal framework for suicide prevention, Health Canada said in a statement. 

Where to get help

Kids Help Phone – 1-800-668-6868 (Phone), Live Chat (online chat counselling) - visit www.kidshelpphone.ca

Canadian Association for Suicide Prevention: Find a 24-hour crisis centre

If you're worried someone you know may be at risk of suicide, you should talk to them, says the Canadian Association of Suicide Prevention. Here are some warning signs: 

• Suicidal thoughts.
• Substance abuse.
• Purposelessness.
• Anxiety.
• Feeling trapped.
• Hopelessness and helplessness.
• Withdrawal.
• Anger.
• Recklessness.
• Mood changes.