This article was originally published in the Canadian Journal of Psychiatry, Volume 26, Issue 4, April 2017

A letter to the editor of Canadian Journal of Psychiatry in response to Dr. Kutcher et al’s Perspectives opinion column, School- and Community-Based Youth Suicide Prevention Interventions: Hot Idea, Hot Air, or Sham?

Dear Editor:

Suicide is a public health crisis in Canada. More people die by suicide every year than in car collisions (Statistics Canada, 2015; Transport Canada, 2015). While suicidality is often attributable to mental health challenges, there is no single reason why people kill themselves. It behooves us to acknowledge the complexity involved and the collateral damage wreaked by each suicide death, and the collective impact felt across our community. Effective suicide prevention requires collaborative mental health and public health efforts (World Health Organization, 2014).

Canadians are no strangers to the strained medical system. It is not health care, but rather a medical system: one that focuses on illness treatment rather than health promotion and is designed with clinicians in the centre and patients on the periphery. This model works for many morbidities and given an ample supply of clinicians, this system could theoretically work to treat ill people and catalyze their recovery from all illnesses. But what happens when there is a shortage of clinicians? Or beds? Or steep barriers to care including long waiting lists and large geographic distances? And where does health promotion and disease prevention enter the equation? How can we complement our medical system? The answer, of course, is with community care (Thornicroft & Tansella, 2004).

The notion of gatekeepers – everyday people equipped with the knowledge and skills to respond to someone at risk of suicide – is one such health promotion initiative. The World Health Organization champions gatekeeper training as a key tenet of any suicide prevention strategy (WHO, 2014). This is what healthy community members do: care for each other. If you see people in peril, whether cardiac arrest, diabetic coma or suicidal crisis, the appropriate thing to do is to help them. We all know the universal sign of choking and how to give the Heimlich manoeuver – because we have been trained to respond accordingly – why would we not train people to act as quickly and confidently to aid someone in suicidal crisis?

Will gatekeeper training by itself reduce the suicide rate in a community? No, and nor is it designed to do so. It is intended to be a significant component of a mental health/public health, multi-pronged suicide prevention strategy that involves responsible media reporting, means restriction, research, surveillance and open and easy access to our medical system. In both physical health and in mental health, it is a low-barrier access point to care.

And it works. Just ask the residents of Rosario, a town in Pennsylvania that boasts the lowest rates of heart disease, cancer and suicide. In Rosario, people care for each other, take the time to ask after each other, and leave chicken soup on your doorstep when you’re sick (Gladwell, 2008). The Canadian Mental Health Association has been providing this community care for nearly a century. We have been caring for Canadians’ mental health and encouraging Canadians to care for each other. Gatekeeper training is a critical component of suicide prevention – suicide prevention involves all of us, together.


Mara Grunau
Executive Director, Centre for Suicide Prevention
A branch of the Canadian Mental Health Association


Gladwell, M. (2008). Outliers: The story of success. New York: Penguin Books.

Statistics Canada. (2015). Suicides and suicide rate, by sex and by age group (Both sexes no.). retrieved from

Thornicroft, G. & Tansella, M. (2004). Components of a modern mental health service: A pragmatic balance of community and hospital care. British Journal of Psychiatry,185(4), 283-290.

Transport Canada. (2015). Canadian motor vehicle traffic collision statistics 2014. Retrieved from

World Health Organization. (2014). Preventing Suicide: A global imperative. Retrieved from