Thank you very much.
Honourable chairman, vice-chairs, and members of the House of Commons Standing Committee on Health, I'm very pleased to join you this afternoon to discuss mental health care and suicide prevention in Canada. I commend you for seeking input on these issues of critical importance to the health of Canadians, and I applaud the government's decision to continue supporting the Mental Health Commission of Canada over the coming decade and beyond.
My name is Marnin Heisel. I'm a clinical psychologist, and associate professor and director of research in the Department of Psychiatry at Western University, and a research scientist with the Lawson Health Research Institute in London. My area of research expertise is the study of suicide and its prevention, with specific focus on older adults and other at-risk populations.
In the field of suicide prevention we say that suicide prevention is everyone's business. Globally, over 800,000 lives are lost to suicide every year. In Canada, approximately 4,000 people die by suicide annually, exceeding 10 deaths every day.
Suicide affects all sex, age, and socio-demographic groups, but does so inequitably. Men account for the vast majority of Canadians lost to suicide, with rates highest for those in their middle and older years, and especially for those of European-American background. Between the years 2000-2011, there was a 29% increase in the number of older men and women who died by suicide in Canada. This increase at least partly represents a shifting population demographic; however, we need to work at decreasing the number and rate of suicide, and can't allow them to continue increasing among our most vulnerable groups.
Suicide risk is also high for Canadians living with mental disorders, addictions, a history of trauma, and other factors. We've known these facts to be true for decades, and we have a good understanding of various psychological, social, and biological risk factors for suicide. However, we have much less information on evidence-supported models of suicide risk, of how best to intervene to prevent suicide, and perhaps even less still about how to effectively promote mental health, well-being, and psychological resilience.
Thankfully, this is changing. There's a growing movement among clinical and public health researchers to conduct innovative suicide prevention and intervention research. For instance, my colleagues and I have adapted a psychotherapeutic intervention for older adults at risk for suicide. We've conducted a knowledge translation study, training front line providers who work with at-risk older adults. We're conducting an upstream preventive intervention study of meaning-centred groups for community-residing men concerned with their transition to retirement. I'm facilitating one of these groups this evening, which is unfortunately what prevents me from joining you in person today. These are just a few examples.
There's a growing focus on electronically enhanced therapy for at-risk individuals, interventions with veterans in the military, individuals who self-harm, individuals with a history of trauma, and the list goes on. This is necessary and highly promising work that needs to continue, and to incorporate strong elements of knowledge translation and dissemination to health care administrators and providers, and to incorporate collaborative input from individuals with lived experience.
Learning how best to prevent suicide necessitates expenditure of resources in the form of people, ideas, finances, and political will. I'm very pleased that the Federal Framework for Suicide Prevention Act officially recognizes suicide as a Canadian mental health and public health priority, and outlines the need to raise public awareness, share information, and disseminate statistics about suicide to enhance collaboration and knowledge translation, define best practices, and promote evidence-based approaches for suicide prevention.
With these aims in mind, in 2012 a suicide prevention think tank was convened in Ottawa, serving as an inaugural meeting of the National Collaborative for Suicide Prevention, with representation from researchers, clinicians, government agencies, non-government organizations, and Canadians with lived experience. I had the honour of presenting this research on our knowledge translation study with colleagues at the Canadian Coalition for Seniors' Mental Health. For the last two years I've represented the Canadian Psychological Association on the steering committee of the National Collaborative for Suicide Prevention.
Canada does not currently have a coherent focus for suicide prevention research or intervention. Health care providers and administrators are thus left with a paucity of resources to help them decide how best to respond to the growing need for approaches to detect, monitor, and reduce risk for suicide among their clientele. Hospitals are now required to have processes and procedures in place for suicide risk detection and intervention. Sadly, many lack the expertise or resources to implement these procedures in a sensitive and effective fashion. Although we have the benefit of a strong and dedicated mental health care workforce in Canada, we nevertheless lack clear evidence for proven approaches for translating existing knowledge on suicide prevention into effective service delivery.
All too often I hear the stories of people who present themselves to their health care providers, clinics, and emergency departments but find themselves unable to access timely care and are transferred from service to service, being given recommendations for seeking out mental health services that do not exist in their communities, or being discharged without a clear treatment plan or sensitive follow-up.
Families frequently entrust their suicidal loved ones to our health care facilities for protection. Yet Canadians die by suicide in our hospitals and other facilities, sometimes even when under close observation. Others do so soon after leaving hospital. Some say this is unavoidable. I hope you'll join me in saying that it is unacceptable and that together we will do something to change it.
Given the need for enhanced development and implementation of rigorous evidence-supported approaches to suicide prevention, I propose creating a Canada-wide suicide prevention research network. The primary aim of this innovative network would be to bring together Canada's research scientists, clinicians, policy experts, advocates, and those with lived experience to integrate and quickly disseminate knowledge on suicide and its prevention across diverse content areas, methods, populations, and approaches; to facilitate implementation of large multi-centre and population studies; to respond quickly and effectively to the needs of individuals, communities, families, and government agencies; to train future generations of Canadian suicidologists; to inform sensitive and safe health care practices; and ultimately to help meet our vision for a Canada without suicide. Such a network could thus help ensure successful implementation of the Federal Framework for Suicide Prevention Act and advance collaborative scientific discovery and action to prevent suicide in Canada and ultimately help enhance our nation's health and well-being.
Together with my colleagues at the Mental Health Commission of Canada, the Public Health Agency of Canada, and CIHR's Institute of Neurosciences, Mental Health and Addiction, we will be holding a full-day meeting of more than 40 leading Canadian experts on suicide and its prevention next month in Montreal to begin the process of establishing a new set of Canadian strategic research priorities for suicide prevention. This meeting builds on the successes of a meeting in 2003, with support from the federal government, and aims to benefit from what we've learned over the past decade and focus on where we need to go in coming years. I'm very optimistic about this meeting and aware that, in order to succeed, we need to move beyond setting priorities to implementing them.
In closing, I thank you for your attention and respectfully request your support for three initiatives that can help enhance suicide prevention in Canada.
Briefly, the first is dedicated research funding for suicide prevention. There's great potential value in creating a national suicide prevention research portfolio with dedicated funds for operating and knowledge translation grants, career support for trainees, postdoctoral fellows, new investigators through mid- and senior-career individuals, CIHR or Canada research chairs in suicide prevention, and a national centre of excellence in suicide prevention. Funds could be shared among various government agencies and other funders.
The second is the Canadian suicide prevention research network. For our network to develop and succeed, it too requires dedicated support. We're making great progress in beginning the process of setting strategic research priorities, but this could not have been achieved without the invaluable assistance and support of government agencies; and we have farther to go.
Third is access to psychological services for all Canadians. This week The Globe and Mail published a series of articles calling for increased access to mental health services, including psychological services. I find the movement towards personalized medicine compelling in arguing for the need to tailor medical interventions to individual characteristics. Yet it's nothing new, in that mental health providers have been doing this for years. Psychologists engage in truly personalized health care, providing in-depth individual assessment, treatment planning, implementation, and evaluation; taking into consideration clients' personal and family histories, development, and functioning.
Ideally, all three initiatives would work in concert, establishing a network of researchers, identifying key research priorities, and providing the necessary support to conduct and disseminate innovative and effective research with strong health implications to be implemented in health care services. For instance, research is promising regarding the role of psychotherapy in reducing suicide thoughts and behaviour. Psychotherapy, I feel, is necessary for many if not most individuals at risk for suicide, yet many Canadians cannot afford it.
I thank you very much for your attention.