Preventing suicide in Canada – Key messages
John N. Lavis
What's the problem?
There is a significant burden of death by suicide in Canada, which is driven by a complex set of interrelated factors.
Suicide is the second leading cause of death for those aged 10 to 19, and in 2009 was the ninth leading cause of death overall in Canada. While population-level rates of death by suicide have remained stable or slightly declined in the last decade, death by suicide and suicide-related behaviours continue to disproportionately affect certain groups, with higher rates found among those with mental illness and addictions (a major mental disorder is present in 90% of deaths by suicide and suicide attempts), people who are socio-economically disadvantaged, First Nations, Inuit and Métis populations, and men and boys.
Suicide prevention is challenging given that programs and services need to address a complex interplay of factors at the individual, interpersonal, community and societal levels in ways that are appropriate for different age, gender and cultural groups.
There is a lack of a coordinated, multidisciplinary, inter-sectoral approach to suicide prevention that has long-term sustainable funding and a coordinated governance model across federal, provincial and territorial governments that fits the unique Canadian constitutional context.
What do we know (from systematic reviews) about three viable elements to address the problem?
Element 1 – Develop and implement suicide-prevention strategies in ways that build on strengths, resilience and protective factors
We found several systematic reviews about public-engagement strategies as one component of establishing stakeholder-driven processes, and about supporting the use of research evidence as part of a coordinated knowledge translation initiative to support the implementation of suicide-prevention strategies. While none of the reviews identified benefits directly related to these strategies, they did outline details about their key components and stakeholders' view about and experiences with them.
Element 2 – Foster integration and coordination of new and ongoing efforts to prevent suicide within and across sectors and jurisdictions
Several high-quality systematic reviews found benefits for key components of this element, including:
- interventions (discharge planning and follow-up, crisis interventions, integrated care pathways and assertive community treatment) that could contribute to developing well-defined care pathways and packages of care, and establishing continuity of care
- multidisciplinary teams (e.g., on-site mental health workers and community mental health teams)
- financial and resource mechanisms to support integrated care within the health system and between health and social care systems.
Element 3 – Provide education and training in suicide prevention
We found several systematic reviews outlining benefits related to: training for the provision of culturally appropriate programs and services (e.g., educational interventions aimed at improving cross-cultural communication); interventions aimed at supporting the implementation of practice guidelines (e.g., distribution of educational materials, audit and feedback, educational outreach visits, and local opinion leaders); and mass media campaigns aimed at changing health behaviours (although none of the reviews evaluated campaigns specifically related to suicide prevention or mental health).
What implementation considerations need to be kept in mind?
Potential barriers to suicide prevention in Canada can be identified at the level of individuals (e.g., lack of willingness to engage in stakeholder-driven processes), providers (e.g., giving priority to medical care at the expense of prevention work), organizations (e.g., lack of interest in making long-term sustainable financial commitments), and systems (e.g., lack of interest or willingness to contribute to the development of a shared governance model). Efforts to address these barriers need to be aware of potential windows of opportunity (e.g., increased interest from the Canadian federal government in efforts to support suicide prevention) and learn from other jurisdictions that have successfully developed suicide-prevention strategies (e.g., provinces and territories in Canada and/or other countries, such as the recent revised national suicide-prevention strategy in the United States).
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