The causes of suicide are complex – an interplay of psychological, biological, social and environmental factors, often sparked by a personal crisis like a failed romance. But about 95 per cent of cases spring from a mental illness such as depression or schizophrenia.
With teenagers, who are undergoing a lot of changes, hormonal and otherwise, spotting the warning signs and hearing the cries for help can be particularly challenging, and there is no simple solution. Everyone, from individuals to community groups to governments, has a role to play.
But much can be done. The Globe and Mail's public-health reporter, André Picard, spoke to experts and reviewed suicide-prevention strategies adopted by provinces and other countries to draft this concise, four-part action plan.
The number one challenge is getting timely help.
Local demand for treatment has increased dramatically since the death last November of the 14-year-old daughter of Ottawa Senators assistant coach Luke Richardson. This pleases her parents, whose Do It For Daron campaign urges troubled teens to seek assistance, but it also "causes us anxiety," admits Daron's mother, Stephanie, because the system is so overburdened, fragmented and starved of cash.
"The frustration I hear expressed over and over again is: 'I can't get help,' " says Jude Platzer of Vancouver, who founded the Josh Platzer Society in honour of her teenage son who died 12 years ago.
The wait to see a psychologist or a psychiatrist can stretch for months, even years in most provinces and territories. "When a young person is suicidal, it's an emergency. I don't want to hear about wait lists."
There is also tremendous inequity because those with means can easily access treatment not generally covered by provincial health plans.
Darcie Atkinson-McKee of Ottawa says she thought of suicide every day as a teenager. Luckily, her mother's private health insurance paid for regular sessions with a psychologist, but she finds it "terrifying" to think what might have happened otherwise. "I'm very lucky."
Few family doctors are readily accessible or equipped to provide immediate help to a teenager in distress and young people are not prone to turn to doctors for help. That means those who reveal their despair to friends or family will likely end up in emergency rooms, which are unwelcoming places, although some hospitals – like the Royal Jubilee in Victoria – now have special mental-health ERs.
Ottawa patients wait as long as a year for treatment, but Luke and Stephanie Richardson decided against taking it slow. "The guidance we got … is, if you wait for the system to be ready, it is never going to change," Mrs. Richardson explains. "It is going to have to adjust to the demands of youth."
And there is much adjusting to do, argues Simon Davidson, head of child psychiatry at the University of Ottawa and the Royal Ottawa Mental Health Centre.
In a recent report, he accuses political leaders of turning "a blind eye" to the level of care, noting that "if only one in six adults requiring a hip or knee replacement received one … governments would fall. It should be no different for our children and youth suffering with mental illness. In fact, their services should be a greater priority."
To prevent suicide, you need to identify those at risk. But that is not easy. Many people, especially the young, keep their torment secret and don't know where to turn.
In fact, about half of the young people who take their own lives are in regular contact with the health and social-services systems, with the other half hidden in plain sight (the warning signs often apparent only in retrospect). Dr. Stan Kutcher, the Sun Life Financial chair in adolescent mental health at Dalhousie University in Halifax, says there are good diagnostic methods and treatments but "people are reluctant to come forward when they are sick, and their friends and family members often don't know how to help them. There is still tremendous stigma about mental illness."
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.
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.
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."