Health Advisor is a column where contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.
As we settle into the school year, we're reminded of the stresses our kids can face. Many kids are able to cope with the daily demands of their lives, but for a significant number who cannot, the outcome can be extreme and tragic.
We take stock of what we know about suicide as we acknowledge World Suicide Prevention Day on Sept. 10, especially as it relates to what is happening in Canada. Suicide is the second leading cause of death among Canadian youth 15 to 25 years of age (roughly 10.8 deaths per 100,000 in 2011). As many as 8 per cent of young people attempt suicide each year and roughly 15 per cent admit to thinking about suicide. What is especially shocking is the very high rates of actual and attempted suicide among our First Nations and our LGBT youth and the dearth of interventions developed to address those populations.
Suicide prevention should be on the radar of all politicians and policy-makers; however, in contrast to many other countries, including the United States, Australia and Britain, Canada does not have a national suicide-prevention policy.
A national group of clinicians and scientists from across the country (under the leadership of Dr. Kathryn Bennett, a clinical epidemiologist who works in the department of clinical epidemiology and bio-statistics at Hamilton's McMaster University) has recently finished a review of the world literature on suicide-prevention programs in young people.
They found that actual suicides are much rarer than suicidal thoughts and suicide attempts. They also determined, though, that sometimes young people take their own life without any prior warning.
The good news is that there is evidence that school-based programs can reduce suicidal thoughts and suicide attempts. Additionally, embedding mental-health professionals in emergency departments or in primary-care settings appears to reduce suicidal behaviour.
But there is no real evidence these strategies reduce actual suicides, in large part because the overall rate of suicide is low and we would need studies of very large sample sizes to show an effect.
The story about medication (selective serotonin reuptake inhibitors in particular) is more controversial. There is some evidence that certain SSRIs may increase suicidal thoughts in the first few weeks of starting the meds (but, again, there is no evidence of an increased rate of actual suicide).
On the other hand, the suicide rate among young people has gone down as the rate of prescriptions for SSRIs has gone up. There is also excellent evidence that psychotherapies such as cognitive behaviour therapy can effectively treat depression, which is a strong risk factor for suicidal attempts (as is being impulsive and having an addiction problem).
So how do we begin to address youth and suicide? The key is not to see suicide prevention as a problem to be looked at independent of mental health of young people in general; it's part and parcel of the same thing. If we address the mental health of youth, especially in the 15-to-25 age range, as a public-health priority then we will reduce the rate of suicidal attempts. It's a simple challenge to articulate but who will take up that challenge? As mental-health professionals we cannot do it alone. We need politicians, policy-makers and the general public, as well as those families and youth affected, to join together and tackle this issue head on.
The irony is that the segment of the population most vulnerable to mental-health and addiction problems is the one most poorly serviced by the current (dis)array of services. Youth are not comfortable accessing mental-health services, whether they are housed in a "children's" mental-health agency or an "adult" mental-health facility. The abrupt transition of services when youth turn 18 years of age in most jurisdictions is another policy challenge that must be addressed.
The development of "youth sensitive" services based in the community, but with rapid access to specialized mental-health care to ensure safety and prevent risk of self-harm, would go a long way to addressing this national tragedy that rips so many families apart.
Dr. Peter Szatmari is chief of the Child and Youth Mental Health Collaborative at SickKids, CAMH and the University of Toronto.