Spotlight on suicide

Over the weekend, the Star's public editor, Kathy English, wrote a column about how newspapers have been grappling with the issue of suicide -- particularly on whether it should be reported as such.

For many years, the Star’s policy has been not to reveal that someone committed suicide unless there is some overriding public interest in doing so.

While some here suggest the Star’s policy needs altering to allow more reporting on suicide, I think this is a matter more of conventional practice within journalism — and our society overall — than any newsroom policy. Most any time someone takes their own life, it seems to me there’s a case to be made for “overriding public interest” in seeking to understand why.

Star editor Michael Cooke also thinks we need to report the truth when someone takes their own life. He likens the silence around reporting suicide to a time when people felt shame in talking about death from cancer.

In reporting stories about suicide, the media can spark important public discussion about depression and the serious mental health issues that affect one in five Canadians.

Suicide, as an issue, is very much at the forefront of the news these days -- with a series in The Globe and Mail and today, highly unusually, the Liberals using their allotted opposition day in the Commons to discuss suicide prevention. (Here's Rae's piece in today's Globe, by the way.) We're only an hour or so into the "debate," right now as I write this, but I can report to you, happily, that the tone has been raised several notches in Parliament. Tune in if you can, if you want to see MPs at their best. ***Update*** See transcript below All the silly partisanship is mercifully absent.

In the meantime, I thought you might like to see the responses of Liberal leader Bob Rae and others present at this morning's press conference, when I posed the question about how the media should report on suicides. Should we report it as a cause of death? In their answers (which weren't really answers to that specific question) they gave some more insights into why the Commons is dealing with this issue today.

Bob Rae: I think I'll let the journalists solve that problem. My view is that we're doing our work in Parliament today, not beginning a national conversation, because there's been a national conversation for some time, but by using the pulpit that we have in Parliament to bring people together and to hope to make a difference.

Dr. Paul Links, past president of the Canadian Association of Suicide Prevention: I just want to speak on behalf of CASP. The issue is that we don't want the media not to talk about suicide, that is not the issue. The issue is how you talk about it. Because there's lots of evidence that if you talk about it in an inappropriate way, if you sensationalize it, you can cause copycat suicide. But it's not that we don't want you to be here talking about it. We do.

Senator Romeo Dallaire: An interesting angle to your question is: How many casualties have we had really in Afghanistan? Is it those only who have died in theatre or is it also those who have died at their own hands subsequently because of the injuries, the mental injuries they've had overseas and were not able to handle and have subsequently died here? Are they not part also of the casualty list? And not speaking about it, not recognizing it, to me, both in Veterans' Affairs or in DND to the extent it should, is not recognizing the full extent of the impact of our commitments and the impact of those missions on those individuals and their families.So yeah, it is important to recognize it and count them among the casualties.

Vancouver Centre MP Hedy Fry: I don't want to favour any particular piece of media, but the four-part series in the Globe and Mail has actually brought this forward and they dealt with the issue very sensitively and didn't dramatize it, didn't make it into some sensationalism, but actually talked about the need for a prevention strategy that should be pan-Canadian.

Dr. Nizar Ladha, president of the Canadian Psychiatric Association: You know, stigma is one issue. The other issue is that we have not considered psychiatric illnesses as real illnesses. We have thought of them as something that exists in theory. These are real illnesses and they are not only mental illnesses. They are actually physical illnesses. Just consider a person who's depressed. Appetite is changed, energy is changed, libido is changed. There is a decrease in weight. These are physical disorders as well as psychiatric disorders. We have to understand that these are illnesses with scientific bases and with evidence-based treatments. Just think of the number of people this year who will die from suicide in the world. It's close to 900,000 people. More than any war would kill. The importance of mental illness is enormous. We have to recognize it. We have to put research funding into it. And we have to treat them properly.

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And here is a slightly condensed transcript of the first hour of the debate, to show you that MPs, in all parties, are capable of respectful, dignified debate in our house of Parliament.

Hon. Bob Rae (Toronto Centre, Lib.): Madam Speaker, all of us in the House will recognize and understand that suicide is something that has touched all of us in one way or the other, either as family members or as friends. What we have also come to realize more and more is that this issue can no longer be regarded simply as one of a personal tragedy, which it undoubtedly is, but it also has to be recognized as a political issue in the sense that it is an issue that the public has to take notice of. The good news in all of this is that if we take notice of it and take action, there are actually things we can do to reduce the number of people who lose their lives in this very tragic way.

The statistics are frankly overwhelming. In the industrial world we have a relatively high suicide rate in Canada. We are the only modern industrial country that does not have a national strategy to reduce the level of suicide, to save lives in a very significant way. Canadians would be surprised to learn some of the statistics. The fact that over the last 30 years at least 100,000 Canadians have taken their own life. That is a truly remarkable number.

We heard today from the president of the Canadian Psychiatric Association who told us that around the world last year nearly one million people took their own lives. So we developed this capacity as societies to take statistics and to get the numbers, but it is important for us as a country to be able to take the steps that will make a difference.

... I hope we can all agree that a good society is, among other things, a place where people care about each other, where quite simply we care about what happens to ourselves, we care about what happens to our families, we care about what happens to our friends. However, our compassion does not end at the end of our garden. Our compassion extends to our neighbours. Our understanding of what we in Canada face has to include the fact that there are a great many Canadians who, today, are in turmoil. Today, this day, as many as 10 people will take their own lives. We can all use a bit of imagination and think about who those people are.

Think of a young girl living on a native reserve. Perhaps she has been abused as a child. Perhaps she is living in a house where there are as many as 10 or 12 or 15 people sharing a room. She goes to school and on the computer in the school, she sees a very different world. She sees a world of wealth. She sees a world of opportunity. She sees a world of affluence. She looks around her community and she sees the opposite. And she asks herself, “Where is the hope? What hope do I have?”.

Think of a young boy who discovers in his early adolescence that he is gay, who realizes that his sexual identity is not that of the majority of people in his classroom, who sees himself in a different way and who is looking to find the ways in which he can be as much a person as the person sitting next to him at school. Because he is seen as different, he is bullied. Perhaps one of his classmates goes on the Internet and starts making fun of him, starts singling him out.

Think of the young teenagers who are in turmoil for all kinds of reasons, all of the biological and hormonal and other changes that are happening in a bewildering world in which they are living and in which they have to show themselves to be okay. They are not allowed to be anything other than okay. Perhaps they live in a house where it is hard for them to say, “I'm not okay”.

Think of the veterans who come back from the trauma of the battlefield in Afghanistan who are never allowed to show weakness on the battlefield, who are never allowed to show a moment of vulnerability. When they return, they find a world where they do not know how to be vulnerable. They do not know how to deal with the world in which they are now living, the mundane, everyday world in which most of us live every day.

We cannot explain all of the circumstances.

The number of seniors, for example, who take their own lives is remarkably high, maybe for reasons that have to do with their loneliness, with their vulnerability, with their having felt that they have lived a life and now cannot find meaning or purpose to where they are.

Mental health issues affect one in five Canadians. Yet, it is an issue that is rarely discussed. We have fundraising drives for breast cancer, for prostate cancer, for heart conditions and for all of the other physical maladies, as well we should.

However, we do not have a run for suicide. We do not do a walk for schizophrenia very much. We do not talk about depression a great deal. We let people suffer in silence. We pretend that it is not a problem.

We have made progress. It is not as bad as it was in days gone by. We changed the legal structures. We have accepted, as a society, and we have learned how to celebrate sexual identity.

The Prime Minister gave a wonderful speech in the House, a statement of reconciliation with the first nations people.

... We have made some of the steps that we need to make to begin to create a climate of hope, a climate of mutual care, a climate of love, but our actions do not follow the words.

The motion that is before the House today is a motion that says, first, let us talk about this, let us have a conversation where we discuss frankly and candidly what should not be happening in this country.

Gay kids should not be bullied in school, and schools need to learn how to help kids celebrate who they are, whatever their sexual identity. We should celebrate who we are; that is the meaning of dignity.

If we are a society that believes in dignity, compassion and care, every child has to have pride in that identity and pride in who they are, but it goes well beyond childhood.

Having talked about the motion with some colleagues and decided to put it forward as an opposition day motion, I hope we will have the support of the whole House. I hope we will have a good conversation today and I hope we will have an opportunity for the House to show itself as it can be when we want to talk about issues that are important. We are behind the public. The public is ahead of us.

Today I held a press conference with Stephanie Richardson, whose daughter took her own life last year in circumstances that are well known in the Ottawa area and brought forward an incredible outpouring of emotion, compassion and feeling in the community. That family has done a remarkable thing in turning a terrible tragedy into a moment where they can perhaps teach people what this is all about.

We need to do this as a Parliament. The federal government runs the fifth largest health care system in the country. We are responsible, constitutionally, for aboriginal people and we are responsible for veterans and for our armed forces. The federal government can be a leader in this field, and we have not been.

People say to me, “What about your party when you were in government?” It did not do enough. Nobody can say, from a partisan perspective, “We have done all we can”.

Speaking very personally, having lost some friends to suicide, I can tell the House about the sense of bewilderment that one feels and the sense is, “What else could I have done? What else could I have said? What else could I have seen?”

We know there are strategies that work. We know that if we start to talk about it, it makes a difference. We know that if we begin to create the architecture of support for people and for families, we know if we address the underlying mental health and social and economic issues, that we will in fact reduce the level of suicide. We know that we can find a way to address this question, and we know that it is within our realm of responsibility to do so.

I am one of those people who thinks that the national government has the responsibility to work with the provinces in a co-ordinated fashion, not to dictate to anyone, because seven out of the ten provinces already have developed strategies. However, none of them are sufficiently funded. None of them have enough grounding in this national conversation, which needs to happen.

On behalf of the Liberal Party, supported by my colleague from Vancouver, we have moved the motion, but we do not claim any monopoly of virtue on the motion. We do not claim that we have somehow achieved a breakthrough that others are not party to. There is no reason why any member of Parliament should feel that this is being treated or being put forward in some kind of a partisan way. It is not.

Yes, there will be questions about what could be done, and there will be issues about how we can allocate the funds we need to make sure the conversation happens, but we also understand that there are issues that go beyond politics.

... I have often wondered why it is that governments have such difficulty in accepting that mental illness is every bit as much an illness as a physical illness. My own modest assessment is that there are really two reasons for this.

The first reason is because there is a stigma and a taboo to mental illness that is still with us. We are not as deep and dark in the dark ages or Victorian times perhaps as before but we still have to recognize and admit that it is not seen in the same way and it is not discussed in the same way as it should be. We have made some changes but we need to make more.

The second reason is because people feel, and governments reflect this, that it is an illness but it is not a physical illness. It is something different. People feel that there is not a whole lot they can do about everything, that it is not something that can be easily or readily solved.

This ignores a very basic fact. We have made huge progress in the treatment of mental illness, conditions that were a guarantee of a lifetime of incarceration as recently as 50 or 60 years ago. Conditions today are being treated very effectively with medication and treatment that actually works.

We are behind in research. We are behind in funding. We are behind in support. We are behind in housing. We are behind in all the things that need to be done to really integrate all of these services together. These conditions are solvable. These conditions are matters of political will. These are not conditions which we cannot do anything about.

... A good society is marked by how we care for each other. It is marked by solidarity. So what we are really talking about today is what it is that we owe each other and how our collective failure to reflect in our actions that sense of solidarity and that sense of connection actually contributes to the sense of alienation and bewilderment that is a prelude to a decision to commit suicide.

Not all the explanations are easy. Many of them will continue to baffle people. We all have friends and when they go in this terrible way we say “Who knew, what could it have been?”

What we do know is there are things we can do and that it is not a hopeless situation. It is one where we have to take what my grandmother used to call “the human footsteps”, every day a step forward, taking the human footsteps that take us to the progress that we need to make as a society and as Canadians.

This is a frontier we simply have to cross together. This world of anger, of self-anger, of violence that implodes, of violence that explodes, is a world that we need to understand better and we need to share it. We need to address it and we need to take the steps together as a society that will make a difference.

Hence, the need for a strategy that will in fact prevent people from taking their own lives and will allow them to return, to be there with us, to live full, happy, and productive lives. That is what it means to live in a place where we care for each other.

Mr. Colin Carrie (Parliamentary Secretary to the Minister of Health, CPC): Madam Speaker, I want to take this opportunity to thank my colleague from Toronto Centre for bringing this very important issue forward. As he stated so eloquently in his speech, suicide is something that affects all of us, our families, our friends. Every member in this House I think would state that we should be doing more as a government.

The member is also aware that the Minister of Health is from the north. There is an extremely high rate of suicide in the north, and she is committed to doing more. He also knows about the Mental Health Commission of Canada that was established. It was endorsed by all provinces and territories except Quebec. This is one of the things I would like to discuss with him, jurisdictional issues, because he has a unique perspective being both a federal politician and a provincial politician, and a leader of both parties, in that capacity. He knows about the draft mental health strategy that has been put forth by the Mental Health Commission that will likely address the elements of suicide prevention that he is talking about.

The government is trying to work collaboratively with the provinces and territories within its jurisdictions. I was wondering, does he feel that the federal government can dictate or force the provinces and territories in how they deliver health care services within their jurisdictions? Because this has been a challenge with a lot of these national strategies. Could he comment on that, please?

Hon. Bob Rae: Madam Speaker, I am happy to respond and I appreciate the comments from the parliamentary secretary.

First, as I said in my speech, one of the areas in which the federal government could lead is to clearly understand what we are responsible for. We are responsible for veterans, armed forces and the RCMP. There are significant mental health issues affecting those workers. The whole federal public service is an area where we can lead and do the work.

Second, the member mentioned this and I know the minister has discussed it, but with respect to responsibility in aboriginal issues, we have to recognize that we have not been able to do what we need to do. We do not have the programs in place to be leaders in the field at the federal level.

I appreciate the relatively kind mention, which I am not used to from the other side, with respect to my previous provincial experience. I would say that, yes, of course, the provinces are very sensitive to the federal government telling them what they are going to do, but that is not how it works.

I would hope that mental health would be front and centre on the table in the next round of discussions with the provinces. I think the provinces would be ready and willing to talk about it. Of course, the provinces would look at it from an issue of funding. However, I think the federal government could lead on best practices, which provinces are doing better than others and which provinces seem to have made some success in reducing the incidents.

We have a universal problem, particularly among adolescents, of an inaccessibility to necessary services across the country. No one can look in the mirror and say that we have done enough. We have lots of instances of kids running away from home and they have nowhere to go. We do not have the treatment centres in Canada at the provincial level that we need.

Ms. Libby Davies (Vancouver East, NDP): Madam Speaker, first of all I thank the member for Toronto Centre for bringing this very important motion forward today in the House. I think it is good that all parties are having this debate and that we are focusing attention on this enormously important public health issue. This goes beyond the issue of personal tragedy, it is a public health issue.

The motion speaks about establishing a fund for a national suicide prevention strategy. To follow-up on the parliamentary secretary's comments, I think there is a great vacuum and a dearth of federal leadership. We have seen the Mental Health Commission do some work, but there has not been any kind of focus on a suicide prevention strategy. Rather than suggest that somehow the provinces and territories would have their toes stepped on, I think there would be a welcoming and opening of the debate and dialogue if such a motion passed in the House and the federal government actually took it up.

I wonder if the member could speak a little more on what he envisions in terms of establishing a fund for a national suicide prevention strategy.

Hon. Bob Rae: Madam Speaker, I thank the member for Vancouver East. I have visited her riding on many occasions and I think our ridings share many qualities in terms of some of the social challenges that we face together.

The reason we discussed a fund is quite simple. It is not about dictating to the provinces, but about saying that we do not regard the Mental Health Commission as a boutique project. If it is going to succeed, the Mental Health Commission has to be followed by a serious commitment to actually move these programs forward.

I think the mental health initiative, which I certainly supported, was one where, to be fair, the Prime Minister actually recognized as an area where governments had not done enough. There is a lot that we know we have to do. We have to sit down with the provinces and talk about how a fund could be put in place, what the fund would be used for, how the provinces would draw on the fund and the steps that need to be taken.

To use a phrase that I used in another place at another time, we do not need another federal boutique project. We need a serious exercise in partnership. We also need to recognize that the federal government runs the fifth largest health care system in the country. It is not a bit player, it is a major player and it has to take its responsibility seriously as we go forward.

Mr. Kevin Lamoureux (Winnipeg North, Lib.): Madam Speaker, I would like to pick up on the word that the leader has used in terms of a partnership.

As an MLA for 18 years in the province of Manitoba and even as a health care critic, there was the issue of trying to get stakeholders to come together. When I talk about stakeholders, I am speaking about the different school divisions and, to a certain degree, the municipal governments. I recognize that there are stakeholders at the government level, the non-profit level and a lot of individuals who have a vested interest.

I am wondering if the leader could provide some comment in terms of how it is that the leadership needs to come from Ottawa to bring stakeholders together to draft the overall strategy.

Hon. Bob Rae: Madam Speaker, we have actually done it before. We have done it on cancer. We have done it together on a number of issues where the federal government has played a very useful role. We are way behind where the experts are. The experts in the field are in our psychiatric hospitals, community-based care system, associations across the country, those who have been clients of the mental health care system and are very active patients and groups in provinces and cities across the country. There is a huge network of people who are working in this field. I am not suggesting for a moment that somehow we are inventing a set of answers.

There is the Canadian Association for Suicide Prevention, which, as we speak, is meeting in Vancouver. It has itself come forward with a strategy that it wants to recommend to government.

We do not have to reinvent anything here. We are not imposing anything. It seems to me we are using this debate, and I hope the government will take it up with some action to follow, to say there are some very specific things we can do and we very much hope that is an attitude the government will take as a result of this debate.

Mr. Colin Carrie (Parliamentary Secretary to the Minister of Health, CPC): Madam Speaker, I am pleased to rise in the House to speak to the importance this government places on mental health of Canadians and in particular the prevention of suicide.

What is the face of suicide? Suicide is preventable. Many of those who attempt suicide want to live, but are overcome with grief or emotional pain and cannot find any other way to handle a situation that has become impossible to bear.

Most people who commit suicide give warning signs or hints of their intentions. Community-based organizations across our country help people in their jurisdictions learn how to recognize these signs and how to respond to them. In the four out of five people who die by suicide there has been at least one previous attempt. Suicide occurs across all age, economic, social and ethnic boundaries.

Statistics Canada 2007 figures regarding suicide in Canada show it as one of the top 10 leading causes of death in our country accounting for over 3,700 deaths. Males die by suicide more than three times as often as females, but females are three times more likely to attempt it than males. As well, the survey revealed that over 14% of Canadians have thought about suicide and more than 3% of Canadians have attempted suicide in their lifetime.

Although suicide rates have traditionally been highest among elderly males, the current impact of suicide on society shows its increasing frequency among our youth. Worldwide it is now one of the top five leading causes of death among young people aged 15 to 34. In Canada in 2005, suicide was the second leading cause of death among individuals aged 15 to 34, second only to accidents and unintentional injuries.

We are keenly aware that suicide rates are higher among certain populations including aboriginal youth and Inuit living in northern Canada. That is why this government is investing in programs that address this important issue such as the National Aboriginal Youth Suicide Prevention Strategy. Too many Canadian families have to deal with the anguish of losing a loved one to suicide. There is the social impact of losing a loved one to suicide as well.

Suicide and suicide attempts have significant impacts on individuals, families and all of our communities. We can also see some similarities between mental health and suicide as many of the risk and protective factors of suicide are the same as mental health associated problems and illnesses. Both have stigma attached to them that tends to curb open discussions and prevention efforts.

Suicide is caused by a number of medical and social factors including mental disorders, family violence and social isolation. These factors increase the likelihood of poor mental health which in turn can lead to suicidal behaviour. Because suicide has many faces and can impact society in a variety of ways, its prevention must involve all sectors including governments, non-government organizations, academia and the private sector.

There are many levels of government that work in various ways with suicide prevention. Several federal organizations including Health Canada, the Public Health Agency of Canada, the Canadian Institutes of Health Research, Veterans Affairs, Aboriginal Affairs and Northern Development, and the Canadian Forces are working to address suicide and mental health issues.

In the delivery of health care in their own jurisdictions provinces and territories are also tailoring programs and services that respond to the needs of their citizens. Collectively we need to promote positive mental health, intervene early and prevent risk factors for mental health problems which often lead to suicide and suicide attempts.

I am very proud that this government is taking leadership and fostering the partnerships with our multiple stakeholders. For example, in September 2010, the hon. Minister of Health, along with provincial and territorial ministers of health, endorsed the declaration on prevention and promotion. Through this endorsement our governments recognized positive mental health as a foundation for optimal overall health and well-being throughout a person's life. In addition to this agreement, the work of the federal, provincial and territorial Public Health Network places a priority on mental health promotion and mental illness prevention.

... One of our government's accomplishments, one of the health sectors that I am particularly proud of, is the establishment of the Mental Health Commission of Canada. Collaborating with governments, academia, business and other organizations to mobilize leadership and action is central to the commission's mandate.

The commission is presently working on a national mental health strategy. This strategy is expected to speak to suicide prevention as part of a comprehensive approach to mental health promotion and mental illness prevention in our country.

The Government of Canada also funds the commission to address the stigma associated with mental illness through their Opening Minds campaign. This initiative is meant to enhance the public's education through the mental health first aid initiative.

Through the mental health first aid strategy is a belief that it is critical to deal with physical emergencies quickly, but it is just as important not to neglect a mental health emergency. Mental health first aid refers to the help provided to a person developing a mental health problem or experiencing a mental health crisis.

For over four years the program has taught Canadians how to respond to mental health emergencies, enabling them to better manage potential or developing mental health problems in themselves, a family member, a friend or a colleague.

To date, well over 42,000 people have been trained across Canada. The program is available to anyone interested in learning mental health first aid, including employees such as human resource managers, teachers, counsellors, transit workers, nurses and police officers.

This initiative does not teach people how to be therapists but does teach how to: (1) recognize the signs and symptoms of mental health problems; (2) provide initial help; and (3) guide a person toward appropriate professional help.

A basic instructor course is also offered that is designed to equip those who want to train others in mental health first aid. An instructor course is specifically designed for people who work directly with our youth. Originating in Australia, the program has 505 instructors across Canada and is now available in 17 countries.

I am pleased to have the opportunity today to recognize some of the important and significant programs and activities in the country that are making a real difference in the lives of Canadians. Notably, several provinces and territorial governments, such as Nunavut, British Columbia, Alberta and New Brunswick, have established strategies to promote mental health and prevent mental illness and suicide.

The Nunavut suicide prevention strategy outlines plans and a common direction to the suicide prevention efforts of communities, organizations and governments in Nunavut. Demonstrating the need for and the value of working together, the strategy is a result of a partnership between the Government of Nunavut and Nunavut Tunngavik Inc., the Embrace Life Council and the Royal Canadian Mounted Police.

Another important example is New Brunswick's provincial suicide prevention program. Connecting to Life is a strategy that coordinates suicide prevention activities and intervention services in the province. Community action, continuous education and inter-agency collaboration are central goals of this program.

The Alberta suicide prevention strategy is a 10-year plan that includes both actions targeted at the general populations, as well as at identified priority groups.

In British Columbia, suicide prevention forms a key part of the province's 10-year plan to address mental health and substance abuse.

The government also recognizes, in addition to the provincial and territorial initiatives, the important contribution made by civil organizations, such as the Centre for Suicide Prevention. The centre provides resources and training, including workshops and online courses, for professionals, caregivers and community members.

As well, the Canadian Association for Suicide Prevention plays a role in facilitating information sharing, advocating for policy development and supporting excellence in research and in service. The Canadian Association for Suicide Prevention is currently in the middle of its three-day national conference.

There is also a broad array of community organizations that support individuals and families dealing with suicide and mental health problems. Notably, the Canadian Mental Health Association is a national network with local and provincial branches carrying out public education and providing local support to individuals with mental health problems.

Their mandate is to develop a mental health strategy for Canada, and through this the creation of opportunities where the protective factors are enhanced and the risk factors of suicide diminished.