School is the ideal setting for prevention. Boards of education are bombarded with requests to implement health-promotion programs, and suicide-prevention lectures in particular, although there is little evidence they’re effective.
Rather, research shows the best route is promoting mental wellness, to give young people tools for dealing with stress and emotional challenges, and a sense of where they can go for help. Having that help (a guidance counsellor or school nurse) readily available is also essential. Increasingly, sport and community groups realize that young people in distress don’t necessarily turn to their parents but may confide in a trusted coach, teacher, religious figure or employer.
There is also a need to create an environment where people are more comfortable seeking help. That’s why many countries have invested in anti-stigma campaigns, something the new Mental Health Commission of Canada has made a priority.
While youth suicide is rare, some behaviours indicate young people at a higher risk: those who routinely cut themselves, binge drinkers, gays and lesbians, victims of sexual abuse and aboriginals. Young men are about five times more likely to die of suicide than young women, and they are particularly hard to reach.
Risk can also be reduced by such tactics as placing suicide barriers on bridges and removing potentially lethal drugs and weapons from the home. But limiting opportunity is limited itself: Most youth suicide involves hanging.
INTERVENTION
Suicide hotlines have existed since the early 1960s and “research shows that they really do help people,” says Brian Mishara, director of Montreal’s Centre for Research and Intervention on Suicide and Euthanasia.
But they should adapt with the times. In many countries, counsellors now respond to crisis calls by text message, a method young people prefer and one being adopted in Canada by the Kids Help Phone.
Ultimately, however, “hotlines aren’t enough,” Dr. Mishara says. “They just help direct people to help. The help has to be there.” And that remains Canada’s biggest failing.
AFTERCARE
Strange as it may seem, one of the more neglected ways to prevent suicide is follow-up care for friends and family of those who have died. Bereavement support is essential because losing a loved one can trigger suicide by those with mental-health problems.
There is much debate about the so-called “contagion effect” – the fear that one suicide (and the attention it garners) will trigger others, a particular concern with young people. Schools should have a crisis-response protocol that kicks in if there is a student suicide.
It is important too to invest in data collection (many suicides are not reported as such) and research because little is actually known about which prevention methods work best in specific groups, such as youth.
With a report from Anne McIlroy in Ottawa
Success story in Quebec
There is clear evidence that suicide-prevention measures work.
In the 1990s, Quebec had the highest suicide rate in the country, particularly among young people, an issue brought to the fore by the suicide in 2000 of André (Dédé) Fortin, lead singer of the popular rock group Les Colocs.
The intense media coverage of his death prompted the province to adopt the country’s first suicide strategy, entitled Help For Life. It had four main components:
– consolidate and bolster health services to ensure help can be provided quickly; there was also an emphasis on getting mental-health services to high-risk groups like homeless youth;
– promote mental health and wellness in young people with changes in school curriculums and the funding of community groups;
– launch a broad anti-stigma campaign;
– make suicide more difficult, for example by installing barriers on Montreal’s Jacques Cartier bridge.
In the 10 years since the strategy was adopted, the youth suicide rate in Quebec was cut in half.
“We know what to do …,” said Brian Mishara, director of Montreal’s Centre for Research and Intervention on Suicide and Euthanasia. Dr. Mishara said. “We just have to do it.”
