126 Suicide prevention in Canada

Suicide is a major public health problem in Canada. While several different initiatives have been made since 2000 to develop and implement a national strategy, the Canadian Government still has no public suicide-prevention programme. However, a few Canadian provinces and/or jurisdictions currently have or previously had a defined and/or implemented suicide prevention programme or targeted strategy. This chapter describes the major points of these strategies and identifies areas of concern.

Suicide is a major public health problem in Canada. Over the last decade, total Canadian suicide rates have remained relatively stable, hovering between 11 and 14 per 100,000 individuals (Statistics Canada 2002 and 2008). However, substantial regional variation has been the norm, with significantly higher rates in provinces such as Quebec (18 per 100,000 in 2002) and Alberta (13.8 per 100,000 in 2002) and staggeringly high rates in some of the primarily Aboriginal northern regions, especially in Nunavut, where total rates were 79.8 per 100,000 in 2002 (142.1 per 100,000 among males) (Statistics Canada 2006).

The Canadian Government has been debating with the issue of implementing a comprehensive national strategy on suicide for decades (Leenaars 2000). A number of efforts have been made in order to foster interest and implementation of a national strategy on suicide. These include the development of a White Paper in 1970 (Health Canada 1970), which identified suicide as a major public health problem, as well as a series of other initiatives, such as a National Task Force on Suicide in 1980 (Health Canada 1980) and the production of the document Suicide in Canada (Health Canada 1987), both of which established a list of priorities for specific risk groups. More recently, suicide prevention efforts led to the creation of the report of the Royal Commission on Aboriginal Peoples (Health Canada 1995), and in addition, the Blueprint for a Canadian National Suicide Prevention (CASP 2004), which offered a proposed national outline for suicide prevention. Finally, in 2006, the report of Canada's Standing Committee on Social Affairs, Science and Technology, also known as the Kirby report and titled Out of the shadows at last, like many previous publications, called for federal, provincial and territorial governments to work with stakeholders to develop a truly Canadian suicide prevention strategy.

In parallel, a number of non-governmental national advocacy agencies, such as the Canadian Mental Health Association and the Canadian Association of Suicide Prevention, and several provincial organizations, such as the Center for Suicide Prevention in Alberta, the Association Québécoise de Prévention du Suicide in Québec, SAFER – the Suicide Attempt, Follow-up, Education and Research Program – in Vancouver, played and continue to play an important role in response to the promotion of suicide prevention in Canada. Yet the Canadian Government still has no public strategy in order to prevent suicide.

In Canada, the mandate to provide direct health services falls under the provincial jurisdiction. This explains the difference in the delivery of health policies between different Canadian regions. As such, a few Canadian provinces and or jurisdictions currently have or previously had a defined and/or implemented suicide-prevention programme or targeted strategy. The following paragraphs provide examples of the main points contained in some of these programmes.

In 2005, the Alberta Mental Health Board led a collaborative effort of provincial and federal government ministries, survivors, regional health authorities, and non-governmental organizations to create the Alberta Suicide Prevention Strategy. The following are the main goals and objectives of this strategy:

In 1989, the New Brunswick government established a provincial committee to advise mental health services on strategies to be developed, implemented, or reviewed with regard to suicide prevention. It also worked with New Brunswick organizations to coordinate provincial efforts and to develop a common province-wide approach. As a result, a suicide prevention programme was developed aiming to reduce this province's suicide rates. As part of this programme, a provincial suicidologist has the key role of promoting province-wide leadership on suicide prevention. The service delivery is provided primarily at the community-based level. The New Brunswick Suicide Prevention Program mobilizes agencies and individuals who work provincially and locally. Thirteen community suicide prevention committees are in place throughout New Brunswick's health regions. They advise their local community mental health centre and the provincial suicide-prevention committee on the actions required in order to meet the programme's objectives. They also work with other regional organizations to coordinate their efforts.

As for the province of Québec, the provincial government launched in 1998 a province-wide strategy for suicide prevention called Québec's strategy for preventing suicide: help for life (MSSS 1998). Seven objectives were included in this five-year programme:

A number of actions reinforced by this strategy have been implemented and are functional, such as a 24-hour crisis line service, crisis intervention in all regions of the province, early prevention, post-vention services and information and support to family members.

The Québec strategy for suicide prevention, however, was not renewed when the initial five-year period ended. Instead, the Québec provincial government proposed a broad mental health plan that contained an unspecific and extremely general suicide intervention/prevention plan. Accordingly, in this three-year strategic plan, two objectives focused on suicide intervention: (1) Intervention and support for individuals in crisis, especially adult men, and (2) Intervention for high-risk individuals. This mental health action plan, however, has been difficult to implement, having met stiff resistance from a large sector of mental-health-care professionals from this province, primarily because of resistance to changes imposed by the government in the structure of mental health-care delivery practices.

Other provinces have also proposed suicide prevention plans. Of note, the territory of Nunavut released its suicide prevention strategy on June 2007. In a territory where suicide rates are among the highest in the word, and where suicide has such a devastating social impact, a suicide prevention plan was long overdue. Unfortunately, this territorial government plan, which was noted for its lack of specifics, was built without input from the professional community, with no representative public consultation, and it was not evidence-based. Another province which has been criticized for its lack of a comprehensive suicide prevention plan is Ontario. This province has not defined and/or implemented a strategy addressing suicide, except for a province-wide, tool-free telephone and Internet counselling and referral service targeting youth. However, extensive condemnation has done little to change this long-standing situation.

In the midst of this regionally heterogeneous reality, Canada is still waiting for the Blueprint of a Canadian National Suicide Prevention to be pushed ahead. The Blueprint is the outline of a national suicide prevention strategy for Canada. It is also a policy agenda, a national task list, and tool for identifying best practices, and a roadmap to and integrated solution. The following guiding principles were used to guide the development of this blueprint:

Many suicides are preventable. A recent meta-analysis identified physician education in depression recognition and treatment, as well as restricting access to lethal methods, as the only two suicide prevention strategies with evidence of effectively reducing suicide rates (Mann et al. 2005). Realistic opportunities exist for saving many lives in Canada. With the development of a national suicide-prevention strategy that is based on evidence and contains specific plans of action we will be able to make substantial gains in the battle against suicide. Unfortunately, in Canada we are still waiting for such action to materialize.