REPORT TO THE PARLIAMENTARY COMMITTEE ON PALLIATIVE AND COMPASSIONATE CARE
SUBMISSION FROM THE CANADIAN ASSOCIATION FOR SUICIDE PREVENTION
“SUICIDE- A NATIONAL TRAGEDY, A NATIONAL DISGRACE”
The Government of Canada has seen the statistics on suicide, and still Canadians ask how many more people need to die and families be torn apart before our federal Government recognizes and publically acknowledges suicide as a major public health issue. In a letter that the Canadian Association for Suicide Prevention received early this summer from the Federal Minister of Health it was clear that with the exception of First Nations and Inuit youth, suicide was not viewed as this government’s business, concern or a priority. Suicide affects everyone and is everyone’s business. Suicide prevention requires that every level of government do its part as an equal, active and full partner with community counterparts. No one can say that suicide is not their business or that they have done enough .
Both the United Nations and World Health Organization (WHO) have recognized suicide as a serious and priority public health issue. In 2002 the WHO reported that close to a million people die each year as a result of suicide, more than the combined total of deaths from wars, homicide and civil strife. Next year it is expected that once again more than 4,000 Canadians will die by suicide, affecting thousands of families. Of 82 countries reporting suicide statistics Canada ranks number 26, putting us in the top third of countries with the highest rates. Chances are most people have been affected one way or another by suicide and know someone whose sense of hope was overcome by feelings of despair and died by suicide. The pain for survivors is unspeakable, the loss to our communities incalculable and so often it was preventable. Sadly when someone dies by suicide the pain is not gone: it is merely transferred to family, friends and community. The death of one person by suicide affects parents, children, siblings, grandparents, friends, co workers, teachers and entire communities. In Canada the number of people affected by suicide is estimated at 3,000,000. The tragedy of suicide is that suicide is preventable, we know what to do and how to save the lives of those who have lost hope and struggle with living. Suicide is complex and solutions are not simple. There is no injection available that offers protection from suicide like the millions that were given out and the billions of dollars that where spent to prevent H1N1, another scourge our country faced and to which the federal government responded to so quickly and with leadership.
Once a world leader on suicide prevention, Canada now lags shamefully behind most other industrialized countries. Canadian expertise has figured prominently in the development of international guidelines for suicide prevention. In 1993, at the invitation of the UN Centre for Social Development and Humanitarian Affairs, Canada hosted an international ‘experts’ meeting to develop UN supported suicide prevention guidelines. Following the release of these guidelines both the United Nations and World Health Organization called upon every country to establish not only their own national strategy but also appoint and adequately fund a coordinating body responsible for suicide prevention. Many countries took up this challenge and the UN’s call to action and have since established national strategies, including; the U.S., England, Scotland, New Zealand, Australia, Norway, Sweden to name but a few. While other countries took notice of the UN guidelines Canada did not and continues to ignore them. Not only has our neighbor to the south had a national strategy in place for over a decade, the U.S. government recently announced on World Suicide Prevention Day a national action alliance of public and private partners headed by the Secretary of the Army (former Senator John McHugh) and the President and CEO of the National Association of Broadcasters (former Senator Gordon Smith). The announcement was crystal clear about the government’s intention to update and advance their existing strategy so that it is aligned with current research and best practices and to increase funding for suicide prevention. (It is interesting to note that every World Suicide Prevention Day the Government of Canada is silent, absent and invisible.) Countries such as the U.S. successfully navigated and overcame any issues of federal/state jurisdiction – with political will and leadership we could and can do the same. When it comes to treating suicide as a policy priority on a federal level and appointing a coordinating body Canada has failed miserably and remains out of step and out of touch.
In 2004 CASP published its first Blueprint for a Canadian National Suicide Prevention Strategy. A second edition followed in 2009. CASP receives no public funding or support. The gargantuan effort that was required to produce this landmark document and blueprint was done on the backs of a group of caring and committed volunteers . These dedicated professionals, survivors, social workers, psychiatrists, psychologists, lawyers, academics, concerned citizens and front line workers have given Canada and our government an incredible gift, which our federal government repeatedly returns unacknowledged. This Blueprint has received international recognition and was used by other countries to assist them in developing their own strategies as well as being a valuable resource for many Canadian provinces and territories . At a time when there are so many uncertainties and a challenges facing the average Canadian the need for a national strategy has never been greater . The Blueprint is a proposed national suicide prevention strategy for Canada. It is also a policy agenda, a national task list, a tool for identifying promising practices, and a roadmap to an integrated solution. To prevent suicides we must work together. While many Canadians and organizations throughout Canada have accomplished a great deal in suicide prevention, no vehicle currently exists to express our collective will to build, to share, to learn and to improve our efforts utilizing our collective wisdom, experience and expertise. Suicide prevention, intervention and postvention work in Canada is fragmented and disconnected, with no mechanisms in place to share information and learn from each other. A national strategy and funded coordinating body would ; create that connection, encourage dialogue, support knowledge exchange and growth, provide guidance and direction, promote the consistent use of best practices, offer hope, and send a clear message that this issue matters and is important. By working together we can and will make a difference.
It is indeed an irony and disappointing that in 2009 Parliament tabled a bill that supported assisted suicide before it began a national dialogue on how to prevent suicides. A national strategy must be a pre-condition for any formal conversations on assisted suicide. Assisted suicide is a complex issue that deserves attention and much discussion however it is unfortunate that parliament chose to look at this question before beginning to examine how we as a nation can relieve the mental, emotional and spiritual pain of those people in despair and at risk of suicide and keep them safe and alive.
In 2009 the Mental Health Commission of Canada released “Toward Recovery and Well Being- a Framework for a Mental Health Strategy for Canada”. This important document makes a vital contribution to suicide prevention, it is however not a suicide prevention strategy nor a substitute for one. “Toward Recovery and Well Being” makes only passing reference to suicide and does not specifically include suicide prevention under any of its seven stated goals and priorities. To date when the Government of Canada has been queried about a national suicide prevention strategy the response has typically included that the MHCC framework covers suicide prevention and that the MHCC is covering this issue. Clearly those who respond in this way have not read the document nor consulted MHCC directly. That being said the MHCC and CASP do have common concerns. They share a vision for Canada and currently are seeking collaborative ways to work together to improve the quality of life and safety of all Canadians
When the Government of Canada is not passing responsibility for suicide prevention on to the MHCC the other response has been to pass it over as being a provincial responsibility and declare that the provinces and territories would not want the federal government to interfere. There are many examples of the federal government demonstrating leadership and working collaboratively with the provinces and territories on important public health issues. The most recent example perhaps is the H1N1 pandemic where the Government of Canada was a full partner in fighting this threat to public health and took a leading and prominent role, other examples would include SARS and AIDS. The provinces and territories looked to the federal government for direction and leadership. When one views the Public Health Agency of Canada’s website one can see numerous examples of public health issues where the federal government is involved and supports appropriate responses, issues that when combined result in fewer fatalities than does suicide. PHAC has a mandate that includes health promotion and injury prevention however only passing reference is given to intentional injuries and no mention is made of suicide. The Public Health Agency of Canada does not appear to seriously recognize suicide as a major public health issue in spite of WHO declarations.
While provinces and territories in Canada have opted for different approaches to suicide prevention, most if not all recognize suicide as a major public health issue and support the need for a national strategy and a funded national coordinating body. Provinces and territories are looking for leadership from the federal government to coordinate efforts and promote knowledge exchange between regions. The lack of coordination and the lack of priority placed on suicide prevention at the national level is consistently identified as a real and significant barrier on a regional level.
Suicide affects us all and suicide prevention is everyone’s business, including parliament, all its members and the Government of Canada. All too often suicide is talked about in whispers if talked about at all. CASP is grateful to the Parliamentary Committee on Palliative and Compassionate Care for the leadership, courage, and caring it has demonstrated by its willingness to face this issue head on and talk openly and publically about suicide. We owe it to the memory of the estimated 100,000 Canadians who have died by suicide over the past two decades to talk about suicide and work together to do something to prevent so many unnecessary deaths in the future. We know that suicide is a very real and important concern affecting many people in the final stages of life. Suicide is a problem that will rob thousands of families of loved ones long before their time and deprive our country of the important contributions they could make.
If one examines the impact that suicide and suicide related behavior has on our already overburdened health care system the cost is alarming. For every suicide there are an estimated 22 emergency department visits and five hospitalizations for suicide-related behaviours. It is estimated that in Canada there are in excess of 88,000 visits to emergency departments for suicide-related behavior. In 2004 7,052 Ontarians were admitted to hospital for suicide-related behaviours. Of this group, permanent partial disabilities were suffered by 1,489 people and 76 suffered permanent total disability. Given the need for hospital and/or rehabilitation services, and additional family support following a suicide attempt, the estimated cost of non-fatal suicide related behaviours range from $33,000 to $308,000. There are many other economic costs associated with suicide but they all fade in comparison to the price that is paid by those who lose a loved one to a suicide death.
CASP continues to do a yeoman’s share to promote suicide prevention and the needs of survivors and those with lived experiences of suicide in Canada, with minimal funds and entirely with a volunteer Board of Directors and national office. Many organizations like Klinic Community Health Centre in Winnipeg, which houses the CASP National office, make enormous in kind contributions in order that CASP can continue to exist and carry out this important work. This is an unequal burden and must not continue. Volunteers across Canada stepped in when the Government of Canada did not and would not. Now the Government of Canada must do its part.
The Government of Canada needs to take a page from its own play book and do exactly as it did when it recognized mental illness and mental health as a health priority and established the Mental Health Commission of Canada. By appointing and funding a national suicide prevention coordinating body like CASP, not only will suicide prevention in Canada take an enormous leap forward, the CASP “Blue Print” will in essence become our national suicide prevention framework just as the MHCC document “Towards Recovery” will become the national framework and strategy on mental health.
The Canadian Association for Suicide Prevention is asking that Parliament and the Government of Canada;
- Formally recognize suicide as a serious public health issue and policy priority,
- Commit to working cooperatively with the provinces and territories on establishing a national suicide prevention strategy and establish a federal/provincial/territorial national suicide prevention strategy task force,
- Appoint and adequately fund a national suicide prevention coordinating body that will serve as a knowledge broker, promote knowledge exchange , best practices, research and communication,
- Mandate the national coordinating body to develop and implement a national crisis centre network,
- Mandate the national coordinating body to develop and implement a nation suicide survivors network,
- Mandate the national coordinating body to develop and implement a national suicide awareness and education campaign
Compassionate care is what defines the work and mandate of this parliamentary committee. Compassion is what fuels and drives the Canadian Association for Suicide Prevention. It is our hope that with the support of all committee members we will see the Government of Canada demonstrate its compassion and hear it say “Suicide is a national tragedy and serious public health issue, we must do more, we will do more.”
Canadian Association for Suicide Prevention