March 29, 2023
Briefing note

Suicide prevention initiatives in Canada

Centre for Suicide Prevention

Introduction

Canada needs a national suicide prevention strategy. We are the sole G7 country without one.  A wealth of evidence indicates that having, resourcing and implementing a national suicide prevention strategy reduces suicide. Suicide is a mental health crisis and a public health crisis: initiatives are needed at the individual, community, and population levels to effect change. In its seminal document, Preventing Suicide: A global imperative, the World Health Organization (WHO) asserts that countries need national strategies to effect change. According to WHO, “a national strategy indicates a government’s clear commitment to dealing with the issue of suicide.” The 2014 research asserts an effective suicide prevention plan has elements from four best practice categories: timely access to mental health care, responsible and non-sensational media reportage, reduction of access to means of suicide, and education — including awareness raising, stigma reduction, gatekeeper training, research, and surveillance (WHO, 2014).

An update on this WHO document, Live Life: An implementation guide for suicide prevention in countries, is more explicit in its recommendations. The document emphasizes a “scale up of four key suicide prevention interventions,” which include: limiting access to means of suicide; interacting with the media on responsible reporting; fostering life skills of young people, and early identification, management and follow-up” (WHO, 2022).

Canadian Association for Suicide Prevention (CASP) has called for a strategy since 2004; read their Blueprint here. Centre for Suicide Prevention renewed this call to action after the release of the Federal Framework in 2016, read our article here. A national strategy in Canada will require collaboration between the Federal and Provincial-Territorial (P-T) governments, however, Federal leadership can set P-T partners up for success.

In short, intersectoral action is needed – not strictly a mental health care plan. We need broad based efforts from a variety of Federal and P-T Ministries, including Finance, Labour, Immigration, Housing, Education and specific focus on collaboration with Indigenous communities and agencies including Thunderbird Partnership Foundation, First Peoples’ Wellness Circle, Inuit Tapiriit Kanatami, Métis National Council and the Assembly of First Nations.

Strategy versus a Framework versus an Action Plan

Ideally, a strategy contains a framework; subsequent action plans are then developed to implement the work.

Strategy

  • overarching document tailored to a country’s cultural and social context
  • delineates Federal and P-T responsibilities
  • has dedicated targets, timelines and resources attached to it
  • outcomes are measurable

Canada current state: Canada is the only G7 country without a suicide prevention strategy

Call to action: Canada needs a suicide prevention strategy

Regional, population level examples:

Framework

  • outlines strategic objectives, guidelines and actions
  • does not delineate stakeholder responsibilities
  • does not necessarily have resources or timelines attached
  • no measurable outcomes

Canada current state: Federal Framework for Suicide Prevention enacted 2012; Framework released 2016; reports to Canadians tabled biannually

Regional, population level examples:

Action Plan

  • tactical implementation roadmap with specific objectives, targets, indicators, timelines, milestones, designated responsibilities and budget allocations

Canada current state: Bill 174, passed 2019 enacting National Suicide Prevention Action Plan

Regional, population level examples:

Canadian landscape

The following tables illustrate selected, non-exhaustive lists of current state and future opportunities for Canada in each of the WHO’s four best-practice categories. Some opportunities are more easily implemented than others. Examples of ‘quick win’ opportunities include mandating pharmaceutical companies to use blister packaging, and setting up a forum for journalists to learn about best practices in suicide reporting.

Timely access to mental health care

Talk Suicide Canada: national crisis line

  • Canada has a national crisis line – Talk Suicide developing a competency framework for responders; standardized training

Future opportunities:

  • increase funding to local crisis lines (federal)
  • expand connectivity infrastructure in rural and remote communities, including the north (federal)
  • build out crisis and longer-term clinical care so that crisis line users can receive the further care they need (smooth, timely referrals) (provincial-territorial [P-T])

Implementing 988

  • 3-digit dialing implementation is underway

Future opportunities:

  • continue to support and resource implementation and ongoing service (federal)
  • develop and implement standardized training for responders (federal)
  • build out crisis care quickly; 3-digit dialing in the US resulted in 45% increase in callers in the first 2 months of operations (P-T)

Psychotherapy

  • this is an evidence-based approach for reducing suicide risk
  • currently unfunded federally; some limited funded initiatives in some P-Ts

Future opportunities:

  • work with professional colleges to standardize licensure (cross P-Ts) (federal)
  • resource psychosocial support (P-T)

Standards of practice for health care providing organizations

  • Health Standards Organization (HSO) developed national standard for care, 2022: Suicide Prevention Program

Future opportunities:

  • develop complementary national standards for suicide care including emergency room, follow-up, and patient caregiver supports (federal)
  • this standard will be integrated into the accreditation process for organizations accredited through Accreditation Canada (P-T)

Zero Suicide approaches in health and mental health services

  • implemented at St. Joseph’s Health Care, London, Ontario; St. Joseph’s Healthcare, Hamilton, Ontario

Future opportunities:

  • research and disseminate best practices in Zero Suicide approaches
  • initiate Zero Suicide through health services and provincial bodies

Responsible media reporting

Responsible media reporting guidelines and leadership

Future opportunities:

  • establish and resource a dedicated, national organization to lead safe reporting by providing resources, research, training, and forums to media industry (similar to Mindframe in Australia) (federal)
  • support the creation of guidelines for depicting suicide in drama and film (federal)

Social media

Future opportunities:

  • develop and mandate obligatory supervisory measures for platforms to identify and censor harmful content promoting suicide (federal)
  • mandate educating young people about understanding and interacting with all forms of media (federal)
  • develop and implement curriculum for young people, educating them about interacting with media (P-T)

Reduce access to means

  • The top 3 most-common means of suicide in Canada are: hanging (suffocation), firearms, and poisoning; all other methods are grouped as “other”
  • The top means of non-fatal suicide attempts is over-the-counter medication poisoning

Firearms

  • Canada Firearms Act (1977); amended 1995
  • Bill C-21 passed by Parliament 2022; measures include: implementing a national freeze on handguns to prevent individuals from bringing newly acquired handguns into Canada and from buying, selling, and transferring handguns within the country

Future opportunities:

  • significantly limit gun ownership (federal)
  • strengthen border surveillance on firearms (federal)
  • further gun safety measures can be undertaken that target the safety of those at risk for suicide, as opposed to focusing on illegal firearms (federal)

Railways and subways

  • no policies at present

Future opportunities:

  • Transport Canada could mandate prevention measures such as: reduced access to tracks, identifying and intervening with potential attempters, and technical interventions to minimize harm to attempters (federal)
  • P-T Ministries of Transportation collaborate with Transport Canada for implementation (P-T)

Infrastructure

  • no policies at present

Future opportunities:

  • Federal standards could be developed for infrastructure construction including suicide-safe design for bridges, overpasses, parkades (federal)
  • P-T Ministries of Infrastructure collaborate with Infrastructure Canada for implementation (P-T)

Pharmaceuticals

  • no policies at present

Future opportunities:

  • Health Canada, Federal Food and Drug Regulation could take measures to address accidental or intentional poisoning, for example by mandating blister packaging for over-the-counter medications (federal)
  • P-T Ministries of Health, Colleges of Pharmacists collaborate with Health Canada for implementation (P-T)

Education: Training, Surveillance, Research

Training

  • MHCC training for GPs and RNs
  • HSO standard calls for standardized and routine training
  • CIHR developing national mental health and substance use service standards

Future opportunities:

  • develop and implement national training standards for family physicians and all health and social service providers who have contact with clients considering suicide (federal)
  • work with professional colleges to integrate training into post-secondary programs of study (cross-P-T) (federal)
  • establish training standards for 988 responders (federal)
  • partner with Indigenous communities to host culturally responsive training (federal)
  • work with professional colleges to implement standardized training into post-secondary programs of study (P-T)

Surveillance

  • P-T Coroners and Medical Examiners operate independent of each other; PHAC convening them as a group to explore standardization of death determination practices
  • each P-T has a unique death certificate

Future opportunities:

  • establish a surveillance team to continuously monitor suicide data (federal)
  • develop and implement national death determination standards (federal)
  • develop and implement national standards for what demographic data needs to be collected at time of death (federal)
  • co-develop (with P-T partners) a Pan- Canadian death certificate to collect consistent demography (federal)
  • increase resourcing to Statistics Canada to provide descriptive suicide death reports at regular intervals (federal)
  • maintain Suicide Surveillance Indicator Framework database (federal)
  • facilitate collaboration between all agencies involved in the collection of data (inter- and intra-provincial) (federal)
  • continue to resource CIHI to provide hospital utilization data (federal)
  • P-Ts establish regular suicide data monitoring as Québec does
  • collaborate with Federal and other P-T partners to develop pan-Canadian death determination processes, data collection and analysis

Research

  • dearth of Canadian research
  • rely heavily on USA research
  • PHAC convened the National Advisory Committee on Research and Knowledge Translation which identified gaps in Canadian research and priorities for further study
  • MHCC’s Opening Minds anti-stigma initiative that partners with organizations to evaluate efficacy of stigma reduction programs

Future opportunities:

  • prioritize and invest in Canadian suicide and suicide prevention research

Surveillance and research of MAID where mental illness is the sole underlying medical condition

  • extended this expansion to March 2024

Future opportunities:

  • national surveillance required to determine impact on suicide rates (federal)
  • develop health service and professional policies/guidelines (P-T)

School based programs (to increase life skills development of young people)

  • no policies at present
  • promising practices emerging

Future opportunities:

  • establish national standards for school-based programs (federal)
  • ensure students have support and connections and access to mental health services (P-T)
  • choose evidence-based programming based on the needs of the school (P-T)
  • evaluate efficacy of programs (P-T)