:
Ladies and gentlemen, I ask you to please take your seats. We're right on time, but we have a lot of very important information to go through today.
I'm going to introduce to you, from the Canadian Association for Suicide Prevention, Ms. Dammy Damstrom-Albach. She is the president. Welcome.
We have Ms. Jennifer Fodden. She is from the Lesbian Gay Bi Trans Youth Line. Welcome.
From the University of Western Ontario, we have Dr. Marnin Heisel, associate professor and research scientist, Department of Psychiatry. He is running late. His plane will be landing shortly, so he'll be joining us in a little while.
As an individual, we have Dr. Brian Mishara, director of the Centre for Research and Intervention on Suicide and Euthanasia. Welcome.
And I want to welcome a very good friend of ours, Ms. Denise Batters, the wife of Dave Batters, one of our members who was with us a few years ago.
We are going to begin with Ms. Dammy Damstrom-Albach, please.
:
Good morning, and thank you very much for allowing me to address the committee.
As you are by now well aware, as many as 10 Canadians die each day by suicide, and these mostly preventable deaths devastate the lives of so many others. On that basis alone, our government should play a significant role in suicide prevention. However, this role and the government's response to suicide must be in keeping not only with the seriousness but also with the breadth and the complexities of this issue.
This requires an approach that is authentic, multi-faceted, and nuanced, an approach specific to suicide prevention, intervention, and “postvention”, which of necessity focuses particular attention and action beyond simple inclusion in a broader initiative. Positive outcomes demonstrating our government's true commitment to suicide prevention depend upon specific, comprehensive, and concrete action, and eventually upon appropriate funding as well. While we understand funding for suicide prevention is not part of today's discussion and cannot be tied to a private member's bill, we all appreciate that it must at some point enter in.
Bill is a first step. Because of this bill, as well as that tabled by Megan Leslie and the recent motion put forward by Bob Rae, Parliament at last has broken its silence on suicide to join in a national conversation. We are very grateful for that.
However, I believe we owe it to Canadians to figure out what it will take to do this right. We must use this bill as a compass to chart our best direction, not take half measures. We know parliamentarians of every stripe are deeply concerned, and many have been personally touched by suicide in some way, as we saw last October when so many spoke of the tragedy of suicide and the need for bold action.
We are told that for every suicide death, there are at least 10 close others whose lives are profoundly impacted. That is 100 Canadians every day. Think about what that means over a decade. Many of these survivors suffer in silence and may themselves become vulnerable to suicide, particularly without compassionate and knowledgeable care and support.
Yet suicides are for the most part preventable. There are solutions, though they are rarely quick or simple. Suicide prevention in Canada is fragmented. The work began with dedicated individuals and small organizations scattered all across the country, and this remains reflected in our current state. There is no national vision unifying our efforts and few mechanisms that allow us to learn from and build on our knowledge and experience. At times, knowledge is confined to special interest or otherwise privileged groups and not easily accessible or transferable to grassroots organizations, front-line workers, and survivors.
When it comes to suicide prevention in Canada, the right hand often does not know what the left hand is doing, even though there are investments being made and great things being done in pockets all across the country. Because of this, good investments can fail to have broad impact, and their usefulness is then diminished.
Indeed, our government has made some focused investments in suicide prevention, but there is no structure to facilitate benefits spreading to all the places where they could be useful. A case in point is the recent announcement by the federal Minister of Health regarding a $300,000 grant to research best practices. This decision was made with the very best of intentions. However, in the absence of a framework and coordinating body, the government was unaware that similar exercises had taken place in other countries and that in 2003 the Canadian Institutes of Health Research had commissioned Dr. Jennifer White to undertake a Canadian suicide research review. This report identified substantial Canadian contributions to the suicide knowledge base and identified important research gaps. Hopefully, the upcoming research will build on Dr. White's 2003 report. In fact, an update of this report, with the addition of the global picture from similar recent reviews, would likely have been more sensible, along with funds directed to addressing some of the gaps already identified.
The assumption that simply making gathered knowledge available means that it will be swiftly put into action ignores the transitional steps needed to turn evidence-based knowledge into useful, practical application. Furthermore, the rapid gathering of this information could have been done in a few weeks by a simple request to SIEC, the Suicide Information and Education Centre, and to Crise to provide the latest material compiled across the globe.
We may well be spending $300,000 to reinvent the wheel. The government cannot be faulted, because there is no structure or appointed body to inform such decisions, nor is there any such structure to ensure that stakeholders across Canada have equal access to gathered information and the capacity to translate it into policy, implement it in practice, and then evaluate the outcome and feed the results back to others who need to learn from them.
This is where the federal government comes in. It is not a small role that the government must assume. It must function as both catalyst and glue to stimulate and cement the needed connections. Suicide prevention requires all levels of government to unite in support of the community groups, survivors, those with lived experience, and the thousands of volunteers who have long done the lion's share of this work. The national government must step forward to do its portion.
The federal government can also address fragmentation by honouring the 1996 UN guidelines on suicide prevention. Surely Canada's approach must be consistent with these guidelines, which clearly state that the litmus test of a country's commitment to suicide prevention is the appointing of a national coordinating body to promote collaboration and collective action and regularly report on progress.
Let us take full advantage of the wonderful opportunity we've been given thanks to the non-partisan leadership of people like Harold Albrecht, Megan Leslie, and Bob Rae. Bill is a good beginning. However, we need to extend our reach to be sure we do all that we can do for those Canadians whose lives have been or may be touched by suicide. Bill C-300 recognizes that suicide is a public health priority; however, it places most of its emphasis on knowledge exchange.
While this is one essential element of a comprehensive approach, knowledge exchange cannot stand alone. At a minimum, we must also consider establishing a national implementation support team to advance a comprehensive federal, provincial, territorial, public, and private response to suicide prevention. We must develop policies aimed at reducing access to lethal means. We must create guidelines and action initiatives to improve public awareness, knowledge, education, and training about suicide. And we must support an enhanced information system to disseminate information about suicide and suicide prevention.
:
Thank you to the members of the Standing Committee on Health for inviting me to provide testimony this morning.
I appreciate the opportunity to highlight for the committee the particular perspective of lesbian, gay, bisexual, transgender, transsexual, and two-spirit people, which I will hereafter refer to as LGBT for brevity's sake, and our community's relationship with the ideas being discussed today, suicide and suicide prevention.
There are many factors that contribute to a person's risk of suicide ideation and attempts, and while many of these are individual factors, there are also special populations of people that research and experience have shown to be more likely to contemplate, to attempt, and, sadly, to succeed at taking their own lives.
First nations and Inuit peoples and LGBT people represent two of the communities at greatly disproportionate risk relative to the general population. I urge the committee to seek to understand the unique and important factors that affect first nations and Inuit peoples at your next session. Today, I will attempt to present to you the sad reality of the impact of suicide on my community of LGBT people.
I'll begin with a bit of background about myself. I have a master's degree in counselling psychology and I have worked in child and adolescent mental health for 12 years. I'm the executive director of the Lesbian Gay Bi Trans Youth Line. We provide peer support services to youth aged 26 and under throughout the province of Ontario. We serve approximately 6,000 youth each year, providing online and telephone listening, support, information and access to local resources whenever possible. Our services are provided by highly trained youth volunteers who themselves identify as members of the LGBT community.
We do not provide crisis services per se, but the work we do is suicide prevention work at its heart. We provide relief from isolation and we provide acceptance and non-judgmental listening. We provide access to community. Even if it's communicated just by a voice on the phone or an online chat window, it offers a glimpse of hope that can have a significant impact on those who are reaching out.
I want to emphasize for you today the profound ways that the LGBT community is affected by suicide. I have drawn from a number of reliable and peer-reviewed research resources for this presentation today. I will happily share these with the clerk's office if the committee would like access to them after today's meeting.
I'll not overwhelm you with statistics, but I will put before you some of the most stark and revealing numbers. Meta-analysis studies have found that sexual minority individuals were two and a half times more likely than heterosexuals to have attempted suicide. A recent Canadian study estimated that the risk of suicide among LGB youth is 14 times higher than for their heterosexual peers. A large and statistically representative study of trans people in Ontario found that 77% had seriously considered suicide and 45% had attempted suicide. Trans youth were found to be at greatest risk of suicide, as were those who had experienced physical or sexual assault.
What can explain these staggering figures? I want to impress upon the committee that it is not the fact of being lesbian, gay, bisexual, trans, or two-spirit that imposes these risks upon a person's psychological well-being. Rather, it is being a member of a group that experiences oppression, exclusion, omission, and hate that leads to this sad reality.
LGBT people experience stigma and discrimination, and this stigma can have a variety of negative consequences throughout their life span. LGBT people are also targets of sexual and physical assault, harassment, and hate crimes. These pressures, as well as the stress of sometimes concealing one's orientation or modifying behaviour or appearance in anticipation of homophobia and violence, have a negative effect on mental and physical health. Family rejection in adolescence has been linked to increased substance use, depression, and attempted suicide.
Trans people experience even more significant social marginalization in our society. For many who cannot pass as cisgender, or non-trans, the added visibility leaves them more susceptible to harassment and abuse. The cumulative impact of erasure, pathologization, and exclusion leave trans people, and trans youth in particular, vulnerable to suicide. That is what research has been able to demonstrate.
But not all of this is a surprise to those of us in this room. In recent months and years, there have been many stories that have captured the attention of our country's media and viewers at home. There have been stories of young lives ended, just when they ought to be getting started. We have heard tell of homophobic bullying and tormenting that has taken place in schools and online among university students and pre-teens. We have seen video clips filmed by bright and talented young people full of spark whose will to go on has been broken.
As a community, we grieve each of these losses deeply and sincerely. We know that for every one of these LGBT lives lost, there are many more whose stories won't be told because they've taken their secret pain to the grave.
At the Lesbian Gay Bi Trans Youth Line it is not uncommon for our callers to speak about times they had attempted but somehow, thankfully, fallen short of succeeding and ending their lives, and more common still to hear contemplations. Ending it all can seem a very real option to far too many of our kids.
This all sounds very bleak, and indeed it paints a picture of communities in crisis. It is stories like these that have brought us all here today to undertake the important work of making suicide prevention a priority for all, a matter of public health and safety.
The bill before the committee proposes many helpful elements, and I congratulate the authors on some of the following elements in particular. Paragraph 1 of the preamble specifically outlines that suicide “can be influenced by societal attitudes and conditions”, which is the very essence of what I am presenting to you today.
I put to you that you should consider naming the societal attitudes that you refer to in this paragraph more directly: homophobia, transphobia, and racism. Alternatively, naming the communities and populations that are known to be disproportionately affected by this issue could strengthen the impact of this bill.
I offer strong support for paragraphs 3 and 4 of the preamble, particularly the naming of communities as agents of action in both the prevention of suicide and after care of survivors impacted by suicide.
I stand firmly behind the use of knowledge transfer and exchange as mechanisms for change in our public attitude toward suicide, and I urge the government to utilize the research and resources that are available from sources such as Rainbow Health Ontario and Trans PULSE to inform the tools and resources that this bill will stimulate so that the concerns and realities of LGBT individuals and communities are made visible to the general population.
Finally, I urge the committee to look not only to research bodies but also to communities as sources of valuable information, healing, and prevention. Building communities of, with, and for our most vulnerable people can provide the safety net that will ensure LGBT individuals do not become statistics.
Thank you.
:
Thank you. It's wonderful to be here.
Good morning, Madam Chair and committee members. I'm so honoured to be here today.
That news story played last month throughout Saskatchewan on Bell's “Let's Talk Day”. You saw a quick synopsis of why I find myself here today, but here is a little more of my story.
My husband, Dave Batters, and I first met in 1989, in Saskatoon, crossing the street at a political convention. Dave was first elected as the federal member of Parliament for Palliser in June 2004, and he was re-elected in 2006. In fact, Dave was a member of this very committee in his second term in office.
In 2008 Dave became quite ill with severe anxiety and depression. He also overcame a dependency on his prescription medication used to reduce his anxiety and help him sleep.
Shortly before the federal election was called in September 2008, Dave announced he would not run for re-election. He publicly announced why, disclosing the battle he had been waging.
In his words, taken from his press release, he said:
I make this very personal disclosure with the hope that others who suffer from these conditions will seek the assistance they need. There is still a stigma attached to such illnesses and I want to make sure people realize these are conditions that can strike anyone and need to be treated.
Tragically, Dave took his own life on June 29, 2009. Taking a cue from his openness about his illness, we issued a press release disclosing that, sadly, Dave had died by suicide.
Prime Minister Stephen Harper attended Dave's funeral and gave a very important speech. He not only described some of Dave's great personal qualities that made him a valued friend and colleague in the caucus, but he also talked about depression and suicide. One of the most fitting lines of this speech was this:
Depression can strike the sturdiest of souls. It cares not how much you have achieved or how much you have to live for.
In 2010 we held a golf tournament in Dave's memory. I wanted to have the money raised go to a cause that might help someone like Dave. I wanted to produce a TV commercial that targets men between 30 and 50 years old suffering from anxiety and depression. Our golf tournament raised $20,000, and we produced that TV commercial, which ran in Saskatchewan for many weeks. This 30-second ad is still available on YouTube; just search “Dave Batters”. Please view it there and post the link on your Facebook and Twitter pages. I would love to get the number of hits up on this very important message of awareness.
In the Prime Minister's video message sent to our golf tournament, he said:
By publicly revealing his struggle with anxiety and depression, Dave reminded everyone who suffers from mental illness that they are not alone. This is a message that needs to be heard, not just by victims of mental illness, but by everyone, to deepen the well of understanding and support for those battling this disease. This is Dave Batters' legacy.
Many men suffering with severe anxiety and depression think they are alone in their suffering. They think no one else could possibly have felt like this before. We must let them know they are not alone.
Also, many of these people feel they are a huge burden to everyone, and everyone would be better off without them. That is why so many of them resort to this final choice. They need to know their family and friends want to help and don't consider them to be a burden. For those of us now without those loved ones in our lives, we would do anything we could to have them back with us.
Soon after Dave died in June 2009, my counsellor warned me not to get involved with a cause too soon. He knew invitations to get involved would come early and often for me, given my openness about Dave's suicide. That was good advice. But in 2010, when Dave's friends approached me about the golf tournament, the time seemed right for a cause.
I think my difficult journey has been assisted because I was open that Dave had died by suicide. So many people feel that the stigmatized nature of suicide prevents them from discussing the death of their loved one. Some deny the cause of death, or even lie about it. Everyone goes through their own grieving process, and with suicide there are so many difficult and conflicting emotions involved for the bereaved.
I want to talk about Dave, particularly with people who knew him and loved him. I have had many people say to me, “I wasn't sure if I should mention Dave to you, because I thought that might be painful for you.” However, there is nothing that brightens my day more than hearing a new story about Dave. He was such a funny, friendly person. He deserves to be remembered often for all of those great qualities.
Madam Chair and committee members, from my personal perspective, when I look at Mr. Albrecht's bill, these are the two most important aspects of it: the stated goal for increased public awareness and knowledge about suicide, and the federal framework that promotes consultations and collaboration on this urgent health issue all across Canada.
There are many outstanding groups doing good work in pockets across the country. There's a great need for better coordination of these efforts. I believe this will help to give the most important thing of all: hope to Canadians like Dave.
Thank you very much.
:
I'm going to speak in French, if that is all right.
[Translation]
In 1987, the report of the National Task Force on Suicide in Canada provided in its conclusion a series of 40 specific recommendations to prevent suicide in Canada. I was part of the group of experts tasked with revising and updating that first report from the group of experts. Health Canada issued that new version in 1994. Seven years later, we could only reiterate the same 40 recommendations because nothing had been done. Since then, none of the 40 recommendations have been implemented.
Today, close to 30 countries have a national suicide prevention strategy, and the WHO recommends that all countries develop one.
I'm a researcher. Research shows that national strategies have an impact on suicide. For example, a study published in 2011 in Social Science and Medicine focused on the suicide rate in 21 countries between 1980 and 2004. In those 25 years, the suicide rate dropped each year by 1,384 out of 100,000 residents, or by 6.6% a year. According to the study, if Canada, with a population of 34 million, had a national strategy like that of other countries, the number of deaths by suicide would decrease by 476. If we consider the financial impact of health and mental health care and the psychological and emotional impact of deaths by suicide, the possibility of saving 476 lives a year may justify major investments in suicide prevention.
Bill is a good start and indicates that Canada wants to be among a growing number of countries that have invested in a national suicide prevention program. A number of Canadian provinces have already made great strides. In 1998, Quebec created the Stratégie québécoise d'action face au suicide. Between 1998 and 2008, there was a decrease in the suicide rate for all age groups. The rate for youths in Quebec dropped by half compared with 1998.
Certainly, the provinces have a responsibility when it comes to health and mental health. Suicide prevention is part of that. But significant steps at the federal level can contribute considerably to decreasing the suicide rate in Canada. Think about the medication that causes the most deaths by suicide: it's acetaminophen, Tylenol, which is available over the counter in large quantities. In England and in a number of other European countries, a simple regulation aimed at controlling the quantity of pills in a single container that a person can purchase resulted in a lower number of poisonings, whether intentional or unintentional, caused by this medication. The fact that fewer dangerous medications are available at home has reduced the risk for suicidal individuals. This kind of policy doesn't cost the government anything and offers an increased probability of saving lives.
Other examples of possible actions that can be taken at the federal level include media awareness, particularly on the impact their reports have on suicide. This impact has been very well documented through a significant body of research. Encouraging early intervention to promote mental health in young people is another example.
The spirit of Bill is commendable, but the repercussions of this kind of legislation will be determined by the resources available to implement it and how the authorities, which are called relevant entities within the Government of Canada, will invest competent resources to carry out the tasks set out in the legislation.
This bill is very different from the national suicide prevention strategies elsewhere in the world that have had a considerable impact on the suicide rate. The national strategies that have been successful have not given an existing entity the mandate of dealing with suicide prevention; instead, they have created a governmental or paragovernmental organization responsible for the strategy.
Those entities had sufficient funding to interact with the provincial, governmental and non-governmental authorities to develop a concerted action on suicide prevention. However, all the strategies that have been successful received good funding from governments for pilot projects, monitoring and various activities.
Without specific funding allocated to suicide prevention, Bill risks having the same impact as the report entitled Suicide in Canada and the updated report. It was a lot of fine words, but the federal government has taken almost no action in terms of suicide prevention.
Canada has an enormous amount of suicide prevention resources. We are exporters of knowledge in this area. Our research is often used elsewhere. We can learn from the success and experiences at the provincial and local level, but the federal government also has a role to play, as I have already mentioned. I'll repeat that the government just wasted $300,000 to draft existing documents, which have been written recently elsewhere in the world. Lack of coordination seems to be a common occurrence.
Instead of palming the mandate off on a relevant entity within the Government of Canada, I recommend that the bill be amended to create a governmental authority that would be responsible for implementing the legislation. I also recommend adding that this entity make recommendations on changes to Canada's legislation, policies and practices to encourage a decrease in suicide.
Furthermore, I find that the timeframe suggested, which provides for an initial report in four years, must be replaced and that an annual report should be requested. I know that it takes time to establish a strategy. However, other countries in the world have generally taken one or two years to create a national strategy that has involved thousands of stakeholders, given the small amount—
:
Thank you, Chairperson, and my thanks to all the witnesses for being here today.
This is our second meeting on this important issue, and I think we all feel compelled from the testimony we've heard to take much stronger action.
Ms. Batters, thank you for coming and for being so courageous in sharing the experience you went through. I know it's not easy to speak out. I think there is a notion out there that MPs live in this other world, and that we're not connected. For you to be able to explain what happened to Dave and describe how we all suffer from the same ailments, conditions, and mental health issues as the general population helps to connect us with our community and our broader society. I want to thank you for how forthright you've been.
A couple of questions come to mind. To you, Mrs. Batters, who have dealt with this issue publicly, I wonder if you could say a little more about what you think is the immediate first step. We're aware of the stigma. We're aware of how hard it is sometimes for people to come forward to seek the help they need. From what you've learned in working with people, how do you see that important first step? How can we reinforce that in our local communities?
I'll also add another question about whether we need a new national coordinating body. Ms. Albach, you spoke about the UN guidelines and the need for a national coordinating body. I'm curious to know how that works with the Mental Health Commission. We do have the Canadian Mental Health Commission. We hear they're coming out with a strategy in a few months. How do these two things fit together? Do we need a separate entity in Canada that will undertake this, or is this something that's part of the commission's coordination and works?
Those are my two questions. I'd like to begin with Mrs. Batters.
:
In response to your question, Libby, I believe that the reason we need a national coordinating body is in order to specifically focus on suicide.
Now, that's not to say that it isn't crucial that we work in cooperation with the Mental Health Commission of Canada, and indeed CASP is certainly doing that.
I think there is one piece that's very important in what I see so far in working with the Mental Health Commission of Canada. Certainly suicide is addressed here and there when you look at the work that's being done to date. But the real concern is that if it's scattered, without particular focus, then it may continue to support the fragmentation that we see all across Canada.
In national strategies that have been most effective—Scotland, the United States, and Ireland are very good examples—we see that they have actually set up a national coordinating body or a national implementation team that works often as an entity under a larger group that's responsible for broader mental health initiatives and mental illness prevention work in a country. But there's specific focus, within that, on suicide that is very particular.
Our concern, certainly, is that whatever work is done needs to fall under the umbrella, perhaps, of the Mental Health Commission of Canada. But it really needs specific focus on suicide because it crosses so many jurisdictions and boundaries. It needs particular focus and I think a particular action plan in order that we can do the kind of preventative work that we need. Also, provide the appropriate supports to people who have been touched by suicide, who have lost loved ones to suicide. Focus on the kinds of intervention that are required, and certainly that includes the support of community wellness. It includes upstream initiatives that support mental well-being, but it also means that we have to intervene more directly with people who are experiencing suicidal ideation, with people who are making suicide attempts.
I almost imagine that it works a little bit like a Russian doll. Perhaps the Mental Health Commission is the largest doll, but there's a suicide prevention focus and strategy and national coordinating body that fits inside that Russian doll, if that metaphor is helpful.
I apologize for being late and for not having heard my colleagues' presentations. I hope I do not duplicate much.
Honourable members of the standing committee and colleagues, my name is Dr. Marnin Heisel. I'm a clinical psychologist and associate professor at the University of Western Ontario and a research scientist.
My area of research expertise is in the study of suicide and its prevention, with a specific focus on enhancing older-adult psychological resiliency and well-being, improving the psychological assessment and treatment of those at risk for suicide, and developing, disseminating, and evaluating knowledge translation materials regarding late-life suicide prevention.
I'll focus my comments briefly this morning on the potential benefits of creating a viable and sustainable Canadian federal framework for the prevention of suicide, enhancing suicide prevention among Canada's older adults, and highlighting the critical importance of promoting innovation and excellence in the research, development, evaluation, and translation of approaches designed to enhance suicide risk detection and intervention.
According to the WHO, one million lives annually are lost to suicide worldwide. According to Statistics Canada, nearly 4,000 individuals died by suicide in this country in 2008, a figure that we know underestimates the true number lost to suicide but still more than triples the number of those who died by homicide and HIV combined in this country. Far fewer funds are spent on suicide prevention initiatives than on these other important and worthy causes, necessitating a clear response from our federal, provincial, and territorial governments.
Whereas the estimated direct and indirect annual costs of suicide and self-harm in Canada exceeded $2.4 billion in 2004, we cannot put a price tag on the loss of a single human life, let alone on those of thousands. However, we can now all ensure that funds are devoted to creating a sustainable framework for the prevention of suicide for all Canadians.
Suicide is a tragic equalizer. It affects us all, irrespective of age, sex, social class, religion, culture, ethnicity, nation of origin, or sexual orientation. Yet suicide is not distributed equally. Adults over the age of 65 have high rates of suicide and employ lethal means of self-harm, with a high intent to die. Over 6,000 North Americans over the age of 65 die by suicide every year, a number that appears to be increasing with the aging of the baby boomers, a birth cohort exceeding 75 million North Americans and carrying a high lifetime suicide rate.
By 2031, 20% to 25% of all Canadians will be over the age of 65. We're thus now entering an unprecedented period in our history in which a vast population at elevated risk for suicide is reaching a stage of life during which suicide risk is high, and we are not prepared. We do not have a surveillance system in place for detecting or documenting the presence and severity of suicidal thoughts, plans, or behaviour. Our national mortality statistics are incomplete and do not account for provincial differences in the classification of deaths by suicide. Our mental health care system contains numerous gaps through which our most vulnerable routinely fall.
Every year tens of thousands of Canadians join the legions of those of us who have lost loved ones, friends, colleagues, acquaintances, and clients to suicide.
The burgeoning older-adult population will have a dramatic increase in impact on mental health care services for decades to come. Research findings over the last 40 years have consistently shown that up to three-quarters of older adults who died by suicide had seen a family physician or general practitioner in the prior month, and did so significantly more frequently than those who did not die by suicide. The majority of older adults requiring mental health services seek care in primary health care contexts, rather than from mental health specialists. Yet our primary care system was not designed to assess psychopathology or deliver complex mental health care to at-risk older adults.
Multi-centre clinical intervention trials indicate that providing collaborative mental health care to older adults in a primary care medical setting can enhance detection and treatment of depression, increase uptake of mental health services, reduce or resolve thoughts of suicide, and reduce mortality risk. Nevertheless, many primary care providers erroneously believe that depressive symptoms reflect an expected response to age-related transitions and losses, rather than a treatable mental disorder, and neither initiate nor refer at-risk older adults for care.
Clinical guidelines for older adults at risk for suicide recommend interdisciplinary care provision, including access to psychotherapy services and medication where indicated. Unfortunately, many at-risk older adults never receive interdisciplinary care.
In Canada today we lack a sufficient workforce of health care providers trained in gerontology or geriatrics. Geriatric psychiatry is only now receiving recognition as a subspecialty, and geropsychology is at a far earlier stage of development in this country than in the United States. There's a documented need for comprehensive mental health care services for older Canadians and recognition that we have an insufficient body of providers to meet recommended benchmarks for care.
The nature of our mental health system is such that individuals lacking financial resources or extended health care benefits typically cannot access psychological services. In this regard, our American neighbours are in better shape than we are. This is despite the fact that psychological service provision has been shown to create medical cost offsets, reducing or averting usual cost to the health care system.
We must acknowledge that the Canadian mental health care system is two-tiered. Those who can afford private practice services, in addition to those covered by provincial and territorial health care systems, receive far better health care than those who can't. Such social inequity flies in the face of the spirit of universal health care and begs to be rectified.
The field of suicide prevention and research among older adults is in a relatively early stage of development, beginning largely with the study of risk factors. As of 10 to 15 years ago, little data existed on factors protective against suicide risk among older adults or that confer resiliency to suicide in the face of stressors, losses, and other harms. Older adult-specific assessments tools and interventions did not exist.
With research funding from the Canadian government and mental health and suicide prevention foundations, my colleagues and I have begun addressing these gaps. Development of the Canadian federal framework for suicide prevention, dedicated to supporting ongoing knowledge creation and translation can help—
:
We've set up a bank account. It was all very low key. It was just a few of my friends and Dave's friends. Andrew Scheer, who is now Speaker Andrew Scheer, was actually one of the people who helped organize the golf tournament.
We just decided to do this, and then I said, “Let's have the money go to something that would help somebody like Dave.” I really had it in my head that I wanted to do a TV commercial. I was just thinking about times when somebody like Dave was likely to be at his or her lowest. It's fine for people to say, all you need is exercise or fresh air, that'll make you feel better. But if someone is in a deep depression, they probably cannot even get out of bed or off their couch.
So I thought about those kinds of people, and I thought maybe it was a situation where all they're doing is blankly looking at a TV screen, maybe not even paying attention to what program is on. But perhaps if they see this commercial, it would kind of twig with them because it's a guy they can relate to—both the actor in the commercial, and then when Dave's picture is shown at the end—and that just seems familiar to them and they realize they can talk about it with their friends. If their friends ask them, sincerely, “Are you all right?”, they can admit, “No, I'm not all right.” To me, that's the main part of the commercial. When one sees it, that's the major focus of the commercial, which is the man admitting that no, he's not all right.
We know there are a variety of warning signs and things to be aware of. Certainly, signs and symptoms of depression can be an indicator that somebody is at risk. It can include somebody appearing depressed, down, sad, having concentration difficulties, missing appointments, no longer appearing interested in things that used to be of interest to them, and related things like that.
We know, however, with older adults specifically, many older adults can experience a major depressive disorder or a clinical depression without appearing sad or without necessarily feeling sad. We know that with older adults, rather than through psychological symptoms like sadness, depression, loss, etc., many will tend to experience depression through bodily symptoms like aches, pains, and those sorts of difficulties. So certainly we encourage providers who are working with older adults, who are appearing, say, in a primary care medical practice repeatedly for sort of vague symptoms, to begin asking questions about what sorts of things are going on in their lives, how they're feeling, how they're doing, and that sort of thing.
:
Thank you, Madam Chair, and my thanks to all the witnesses for your expertise and for being here today.
You folks are the ones who have been on the front lines of this for years. I simply have the honour of being the parliamentarian who happened to be in the draw of private members' bills in the order of precedence.
Dr. Mishara, one of your concerns was that if there isn't a specific para-government agency charged with the responsibility of taking this task on, it might get lost again. I share your concern, but I need to make you aware that a private member's bill doesn't have teeth. A private member's bill cannot compel the government to spend money. I was trying to get a foot in the door. I am saying this is something the Government of Canada, through one of its agencies—perhaps Health, perhaps the Mental Health Commission—needs to take responsibility for. At some point, the government will charge a specific subagency within that responsibility. That's my hope and my goal. Just to clarify, we're not able to actually set up a commission from a private member's bill.
Jennifer, I share your concerns about not having identified specific groups. I need to tell you it was my intention not to do that, primarily because I was concerned that somewhere down the road we may have neglected a number of groups that were at significant risk. We all know that the aboriginal community is at high risk. You mentioned the LGBT community. We know that the military, and in fact my former profession of dentistry, is at very high risk. We did not address some of those, but we share your concern and we're hopeful that the group who is charged with this will put into place targeted initiatives that will be of help to those specific communities.
Denise, I wanted to thank you for being here. Thank you for talking about your journey and mentioning hope. I certainly agree with Dr. Margaret Somerville, who said,“Hope is the oxygen of the human spirit; without it our spirit dies.” I want to applaud you for talking about it. I can say that speaking openly about our grief is one of the most healing things. I think it's counterintuitive for everybody: they don't want to talk about it. We can say this is one of the most healing opportunities we have, so thank you for that.
Dr. Mishara, you mentioned a number of public health initiatives that could be helpful in reducing suicide. You mentioned Tylenol packaging as an example. You mentioned drugs in the home. I was interested to hear Dr. David Goldbloom say that something as simple as eating with your family can be a long-term protective factor. I think these are the kinds of stories we need to be sharing in our research, in looking at how to carry our long-term strategies into effect.
Dr. Mishara, you mentioned Tylenol and drugs in the home. Could you share two or three other quick examples of public health initiatives that we could be implementing to reduce the incidence of suicide?
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You mentioned data. We know that if we were able to provide data on risk, death, and the kinds of impacts on Canadians in a more timely fashion than we're currently able to do, and share that data all across the country, we could see changes in risk factors and in what was going on for people. If there were a way to make sure that was broadly available, I believe it would make a difference.
For example, in Vancouver, where I work on a daily basis in a suicide prevention agency, although we used to think that women were less likely to use what we call “immediately lethal means”, we're seeing the families left behind by young women who are more frequently dying by hanging. Our sense is that's probably going on in other places across the country, but we don't actually have the data on that readily available. It is important to be able to compile that kind of information, share it broadly, and see if that is what's going on, so we can think about what we can do about this.
Another thing we're aware of—and I'm sure many members are aware of this—is that information is now regularly put forward on the Internet that advises people very specifically about how they can kill themselves, what would be lethal for them, and that suggests that people practise. When we look at what's going on for people who die by suicide, it would be really helpful to know in what circumstances people are actively researching lethal methods. Are there ways that have been developed, in Canada or other countries, to intervene effectively in that whole area of social networking and share that knowledge across the country?
The real challenge is that although an enormous amount of good research is being done in Canada and around the world, the mechanisms for making that research broadly available, particularly to grassroots organizations, are not necessarily consistent across the country. Work needs to be done so that front-line providers can take that research and figure out the best way to implement it into practice on the ground where change is necessary. When we focus on knowledge exchange, we have to look much more broadly at the work we do to determine how it's supported so that knowledge gets down to the front line where it can be used.
I think that's where a national coordinating body comes in that is charged with figuring out the best way to make that available to front-line providers and make sure that people on the front lines are learning what they need to learn to make evidence-based changes in practice that will make a difference. That's across the board, whether you're working with older adults, adults, or young people.
Those are some of the key things that I think we need to address in the bill.
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I could just add that Canada is now moving in the right direction in terms of knowledge application. There's a big emphasis at the Canadian Institutes of Health Research on knowledge application.
The issue, again, is leadership and knowledgeable leadership. The example is that there's $300,000 that I feel is wasted, with good intentions to do some literature reviews, which already exist and which other people have done in the last year. It's just a question of not making strategic decisions in leadership.
Canada exports its expertise in suicide prevention. When the United States government, which supports a national network of suicide prevention help lines, was looking to have those evaluated, our university in Quebec got the mandate to do this, and from our offices in Quebec we listened to 2,611 telephone calls to stress centres across the United States.
But we don't have a national network in Canada to evaluate, and the government does not support such a network. It's a question that whatever funds are already out there should be used strategically to do things that will have an impact. As I mentioned, a lot of the things we can do don't cost anything.
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Thank you, Madam Chair.
Denise, it's great to have you before the health committee. I had the pleasure of sitting on the health committee with Dave during my first term for a few years, and he was always hilarious. He always made meetings entertaining, regardless of the subject. It certainly is a tremendous loss to not have him.
I know you mentioned that he talked about stigma, and that seems to be one of the biggest obstacles when we discuss mental health.
I had the pleasure of attending a mental health meeting in Barrie last week because they're planning a golf tournament fundraiser in June, where they're going to have Shayne Corson, the former hockey player, talk about his depression as a means to.... Their slogan is “Let's Talk”; there needs to be more discussion around mental health. My question is this. What can we do to encourage those discussions? Obviously dialogue is going to help to bring down stigma.
I was thinking back to last summer. I know Mark Strahl mentioned Rick Rypien's death at our last meeting. I know there were also Derek Boogaard and Wade Belak who were front-page stories. If there's a silver lining in those tragedies, it's that it put more awareness than I can recollect on mental health. It was a front-page story for several days in the Toronto area with Wade Belak. It shocked people, because you saw people who were successful, talented, like Dave, who you'd have never thought in your wildest dreams would be suffering from mental health challenges.
What do you think we can do, as a federal government, to try to break down this stigma in particular, to make people more comfortable with having those conversations and asking those questions and seeking help?
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I was mentioning earlier, when Ms. Davies asked me a question, that in recent years, stigma around depression and mental illness has seemed to be improving. But what I forgot to mention at the time was that while that is improving, I'd say that stigma related to suicide is kind of the final frontier of stigma.
What our family did was be very open about the fact that it was suicide. We issued a press release when we announced that Dave had died. The press release said that it was by suicide. We didn't try to sort of hide from that or wait for a report or something like that. Plus, the Prime Minister came to Dave's funeral and spoke about depression and suicide in his speech but also about Dave's life, because sometimes when people die by suicide, it becomes only about their deaths. You kind of forget about their lives. I think it's really important to remember their lives too.
When those hockey players' deaths happened this summer, the Rick Rypien one especially hit me hard, personally, because he played junior hockey in Regina, where we live. Dave and I, I know, would have gone to see him play many times when he played there and in Moose Jaw. And to think about this poor kid....
They had some sort of YouTube video or something like that about one of the last interviews he gave right before he went on a kind of leave of absence, or maybe right after he came back from a leave of absence from the NHL. Just watching him you could see that he was struggling to have hope, but he was trying to keep it together. To think that it had such a sad ending was terrible.
I think it is really necessary when people like that, who people can relate to, people like Dave.... I think some people, when Dave passed away, might have wondered if that guy was really the happy-go-lucky, friendly person everyone saw. Or was that a mask he was wearing to kind of hide this troubled, depressed individual? No, that was Dave. He was happy. Just the last year and a half of his life was when all these medical issues made a happy life tumble down so quickly.
Having those kinds of people and linking it.... You know, there's a lot of openness now about depression and mental illness, but not so much about suicide. We can't forget that suicide is the unfortunate consequence of depression and mental illness. All these groups are being very open with Let's Talk and that sort of thing but then are wanting to shy away from suicide. We should not shy away from the fact that it is the possible result if it goes untreated or is improperly treated.
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Thank you, Madam Chair.
Allow me, as chair of the women's caucus, to take this opportunity to wish all the women here a happy International Women's Day.
I would like to dive right into the matter. My question is for Professor Mishara. I find that you hit the bull's eye, you read my thoughts. We know that in Canada, some 3,700 people commit suicide every year, and 463 of those individuals are between the ages of 15 and 24. We know that a death isn't declared a suicide unless the person had clearly stated beforehand that he or she intended to commit suicide. It's even more tragic when we know that this rate is probably much higher.
In addition, more women than men commit suicide. This is something I'd like to bring up with the specialist, Dr. Heisel, afterwards.
You said that several countries have unfortunately been ahead of Canada in creating a national strategy. In your opinion, what is preventing us from adopting a national strategy here, in Canada? That's my first question.
And Ms. Fodden, you spoke about social attitudes. I am in full agreement with you. Know that if I'm talking like this, it's because I am a doctor by training. We know that, unfortunately, society does nothing at all when it comes to social attitudes toward minorities, regardless of the minority, be it sexual, cultural or something else.
Let's take the example of Ms. Batters. She spoke about her husband, who was very joyful and held a high-ranking position. I can tell you that, even in the medical community, people suffer in silence because society does nothing to demystify the issue, unfortunately. I think it's an illness because it has been scientifically proven that there's a deficit of certain serotonin and adrenalin receptors, and so on.
I find it appalling that the attitude we have is not aimed at demystifying mental health problems and, as a result, suicide.
My question is for both of you. Dr. Heisel, could you tell me why women's suicide attempts are more likely to be unsuccessful, whereas when men attempt suicide, it's fatal?
It's good to be here. I'll echo Dr. Sellah's comments about International Women's Day. Certainly some of the most courageous women I've had the pleasure to meet have been witnesses here at this committee.
Denise, I put you in that category, certainly, today.
I'm going to try to get through this: I didn't have the pleasure of serving with Dave, but I know my family speaks very fondly of him and you.
I'll speak today as well for Ms. Block—who's lost her voice—as a Saskatchewan MP.
Dave had a lot of friends. He was well loved, and he certainly is missed.
Dave was in the system. It sounds like he did seek help and he did receive care. I don't know if he was ever hospitalized or anything for that care, but he wasn't one who avoided the system, and this kind of came out of nowhere.
Were there any gaps in that system? Dave was in it. Did you find any gaps in the system that we should be looking at as we examine the system, gaps that need to be filled?
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Thank you for your question.
We hear very commonly from young people who are struggling to find acceptance within themselves and from the members of their community. That can have a very profound impact on their mental health and the degree of hope they can hold onto for what life holds for them as they come into themselves and into their adult lives.
What I'd like to really emphasize to the committee is that it's not so much any one individual's actions that can have such a grievous impact on a person's sense of worth, but rather the attitudes of the community around the incident or around that person, where there's a benign neglect of the situation, where people turn a blind eye, people don't intervene or call a bully out on their behaviour to communicate to the person who's being targeted that in fact those ideas and ideals are not shared by the broader community. It's when school officials, other students, family members, and the community in general remain silent and don't intervene to let a young person know that they do have value, that they do have worth, and that as a community they can expect a life of their own design, that they can expect to experience love and a sense of value and opportunities. Those kinds of interventions, simple as they might sound, can be really enormously helpful. That's the kind of support we provide.
We operate out of Toronto, but we serve youth throughout Ontario, so we get phone calls from remote communities, where a person feels like the only individual they've ever met who might identify as lesbian or gay or bisexual or trans. They can hear one person 1,000 kilometres away say to them, “You're not abnormal. It's okay to experience the thoughts and feelings and desires you have.” Just to hear that person at a remote location say that and say, “There will be opportunities for you in this life”—and I can say that because I know, because I've been there myself—can be enormously powerful.
In terms of broader social change, we need to create a climate in schools where it's understood to be unacceptable to communicate homophobic and transphobic values on the playground or in the classrooms.
Certainly, those broader initiatives for social change help young people to understand that they do live in a country, in a society, where hate and oppression won't be tolerated.
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Dave was, if anyone knew him, a perfectionist. He was a perfectionist from the time he was a kid.
With that type-A personality he probably always had a certain level of anxiety in his life. Typically he was a high achiever, so he wasn't satisfied with anything other than being stellar at everything he did. He probably had a low level of anxiety throughout his life.
At the same time, he never knew how to leave a job or to have anything other than an absolute 24/7 work ethic. When you're an MP from Saskatchewan, as Mrs. Block can attest to, you don't have direct flights to Ottawa. So you get up at four in the morning on Monday, take that 6 a.m. flight, and when you get to Ottawa you can't just go and have a nap at the hotel; you have to go to question period right from the airport. You have a long day. It's that sort of thing. So there's the constant travel.
He was in a minority government for the entire time he served, and that was a huge difference. I'm happy to see now there's a majority and you have much more stability in your lives, hopefully, with the result of a majority. That was difficult, certainly. But there was the travel schedule, the constant changing of time zones.
Also, the first time Dave won, he won by 124 votes, and that never left his mind. Whereas sometimes people might want to go home on the weekend and not do any events and have a relaxing weekend, we were always going to events. We lost some balance in our life, definitely. Before he was an MP, we'd have date nights and that sort of thing. Date nights went a little bit the way of the dodo bird. Our date nights were now at banquets in Regina and Moose Jaw.
It's always important to keep balance in your life, no matter what your job is. That certainly was a contributing factor.
I mentioned that he had become dependent on prescription pills to help him sleep and to reduce the anxiety, and there's no doubt that was exacerbated during the time he was an MP.
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Thank you, Madam Chair.
I'd also like to thank the witnesses for giving us more information on the strategies that exist elsewhere in the world and what Canada has done over the years.
Professor Mishara, I found it very interesting that you spoke about the 40 recommendations in the previous reports. So far, little concrete action has been taken. The WHO recommends that each country develop a national strategy.This is what is being proposed here, although it is still just a proposal.
Which targets do you think should be given priority? In Quebec, our prevention has been very effective and has decreased the suicide rate in young people by half. I don't know if you have heard about the awareness campaign by Jasmin Roy, a very well known actor and host in Quebec. He is homosexual and was the victim of a lot of homophobia in his youth, adolescence and as he was entering adulthood. He wrote a very provocative book called Osti de fif!, which is a trendy and very common expression young people use, even though it is very destructive.
Could you please tell me about the targets that should be given priority?
I accept my colleague Dany Morin's friendly amendment. I feel that it is very important, given that we have been asking the government, specifically the Minister of Health, questions in the House about a plan to address the drug shortage.
I am sure you must know that Sandoz Canada, located in Boucherville, Quebec, is reducing its production at the moment. We know that, in mid-February, the United States Food and Drug Administration contacted Sandoz Canada and told them that they were not complying with quality standards for the drugs and that improvements had to be made in its production chain. The company agreed to make them. Then there was a fire. Since Sandoz Canada is the main supplier of medications to Quebec, specifically for surgery and for injections, more than 60% of the surgeries in two hospitals, those in Hull and Gatineau, were cancelled. In addition, a number of patients have to wait to have their treatments and to get their medications because of the impeding shortage.
At the moment, there is no plan to help those people. The minister said that she was going to import drugs. While we are waiting, we need a plan. It is very important that there be a plan—