TORONTO – Suicide is the ninth leading cause of death in Canada, according to Statistics Canada. With the exception of accidents, suicide is the only one in the top ten that involves a deliberate action. It’s not the failure of an organ or the invasion of a malignancy and it affects 1 in 13 Canadians.
But public discussion is often hushed by a sense of cultural taboo and media reporting is somewhat muted over concerns that detailing specifics will lead to more victims.
It’s against that backdrop that Toronto’s Board of Health has received a report called “Suicide Prevention in Toronto.”
The challenges of effective suicide prevention are only amplified by the desperation of the statistics presented in the report. It says, “Suicide resulted in 242 deaths in Toronto in 2009, which is four times the number of people who died from homicide, and three times the number who died from motor vehicle crashes.”
The report makes it fairly clear suicide is a significant problem in society. Yet suicide ranks as one of the “least talked about” public health issues.
Much of the media has focused on the report’s recommendations around transit and bridge barriers, primarily because they involve more collateral affects and require significant infrastructure investments.
Installing Platform Edge Doors (PED) barriers on TTC subway platforms could cost as much as $1 billion.
There is also the untold effect that suicides and attempts have on TTC staff. Subway operators, track crews and supervisors all live with the after effects of an “injured customer at track level.”
The “Luminous Veil” has been a success since it was installed on the Bloor viaduct in 2003. But the report authors admit the barrier was successful in “preventing suicides at this site.” Other research suggested the rate of suicide by jumping in Toronto remained relatively unchanged before and after the Veil was built.
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911. 911 can send immediate help. For a list of available mental health programs and services around Canada, please refer to the list here.
Mark Henick is a mental health advocate who works with the Canadian Mental Health Association in Ontario. He notes that “physical barriers are like psychiatric medications: They serve a valuable purpose, address some presenting symptoms and buy you some time, but they often don’t address the underlying cause.”
The most important, and perhaps the most challenging, means of prevention is to recognize those who are at risk.
The TTC has a program called Gatekeeper. It’s a training program for subway maintenance, operating and cleaning staff to help them identify people who may be at risk. Brad Ross at the TTC says “employees are trained in how to keep an eye out for or interact with distressed individuals”.
The TTC has also installed a Crisis Link payphone on every subway platform. Each phone has a direct-dial button that connects callers with a trained counselor at the Distress Centres of Toronto. But Henick says there is some work to be done with this program.
By way of an experiment, he says he called the number connected to the Crisis Link at 9 a.m. on a weekday morning, “and I waited 24 minutes for someone to answer the phone.”
The Crisis Link and Gatekeeper programs are viewed as useful preventative measures but most who would benefit from them are already considering suicide.
The report to the board of health notes only one person who attempted suicide on the TTC called Crisis Link before jumping on the tracks – most fatalities never called.
Henick says we need to be considering means of earlier intervention.
“We know a lot about why people consider and complete suicide,” he says. “So we know that we could be saving people from months or even years of struggle that often lead up to suicide if we actually intervene much earlier in the rather predictable trajectory – before a person even thinks of suicide.”
He says part of that intervention process and providing more support includes an open and frank discussion about suicide and its causes.
“There’s still this lingering myth that if you talk about suicide it ‘gives people the idea,’ but we know that’s just not true,” says Henick. “Talking may indeed uncover feelings and thoughts that were already there. If and when that happens, that’s actually a good thing.”
Ann Marie MacDonald would agree. As the executive director of the Mood Disorders Association of Ontario, MacDonald prefers the unvarnished approach.
“We don’t feel comfortable asking someone directly: Are you thinking of suicide? Have you ever acted in a suicidal way?”
Simply talking about suicide doesn’t promote or cause suicide, she said.
“Someone who takes their life does so because they want the noise in their head to stop. It’s so pervasive that it’s the only thing they can do,” she said.
But extending that discussion in a meaningful way through mainstream media isn’t all that easy.
Media guidelines developed by the Canadian Association for Suicide Prevention, in partnership with the American Association of Suicidology, are effectively aimed at curbing public accounts of suicide. Their supporting research suggests that reporting on specific details, (e.g., method), can encourage copycat suicides, particularly among youths and young adults. The guidelines also suggest that reporting should refrain from romanticizing suicide and avoid simplistic explanations for suicide.
The medical and media caution around the subject reduces suicide reporting to general stories about prevention and alternative measures rather than detailed specifics about the causes and personal struggles.
MacDonald suggests mainstream media focus on the narrative of the entire experience.
“Some stories may be tragic but the good news in the story can be the hope or the support someone received.”