Every day, roughly 11 people in Canada die from suicide.
Multiply that single day by 365 and the figure swells to more than 4,000 people dying by suicide every year.
There is a lot existing research tells us: a close parent-child relationship lowers a person’s risk, cyberbullying raises it, and the risk of suicide is further elevated for people who belong to minority groups or marginalized communities (the suicide rate among First Nations is three times higher than in non-Indigenous populations).
Yet, there’s a lot we still struggle with, like how to accurately predict a person’s suicide risk (or if we should even be attempting to predict risk at all).
And those numbers that do exist — 11 per day, 4,015 per year — come with a notable disclaimer: they’re an underestimation.
If you adjust Canadian suicide rates to include some injuries with undetermined intent then the suicide rates jump by more than 26 per cent for men and nearly 38 per cent for women, according to the results of a Canadian study published in the BMJ medical journal in 2015.
Canada needs a better picture, says Danielle Rice, a therapist and psychology PhD candidate at McGill University.
One thing we do understand? Suicide is preventable. We just have to keep beating back the stigma, connecting the data puzzle pieces, and making sure people get the treatment they need.
A “crucial step” to figuring out why people self-harm and how to help them is “coordinating research and integrating expertise from various fields,” according to a December 2018 report on suicide prevention from the Public Health Agency of Canada.
That report highlights gaps in research and programming, everything from the barriers that can keep someone from disclosing psychiatric disorders to the need for studies that measure the impact of policies meant to help address suicidal behaviour and suicide.
It also outlines the need for research that looks more closely at how to mitigate the impacts of economic hardship on a person’s mental health outcomes.
“For us to get prevention and treatment efforts to the right people we need a picture of potential predictors,” Rice says, “and there are gaps.”
The census captures a lot, she says, but not everyone living on the streets is getting those surveys, not every person who is incarcerated is filling out those surveys, and not every person is seeking care at a hospital.
“We’re missing a lot of these pieces,” Rice says. So, “we get an underrepresentation of the overall prevalence and a biased sample.”
While there have been concerns in the past over substantial underreporting in Ontario, chief coroner Dirk Huyer says that’s no longer an issue.
“We educate about this, we teach about it,” he says. “We take it very seriously.”
And yet, Ingrid Söchting, director of the University of British Columbia’s psychology clinic, worries that suicides still aren’t always registered as such.
One area of concern? Overdoses. “Was it an accident or was it intentional?”
It’s still feasible for coroners to assess “not quite beyond a reasonable doubt, but higher than a balance of probabilities” whether a person’s death is accidental or intentional, Huyer says. Coroners can look at a person’s clinical history and see what drugs they may have used and how high their tolerance would have been.
But in the case of overdoses, Söchting says intentionality may even be confusing for some people who survive those overdoses.
“Drugs can make a person more impulsive,” Söchting says. “They may be ambivalent about wanting to live or not.”
There is also worry that some poisoning deaths, which is the second leading cause of death in suicides, are being misclassified, logged as unintentional rather than a suicide.
This concern was raised in the United States after poisoning suicide rates declined but unintentional or undetermined poisonings rose. Canadian researchers then dug through more than a decade of mortality data to see if the same holds true here.
For all that there are data gaps to fill, Söchting says the work is happening. She pointed to one of her colleagues whose research is focusing intently on the progression from someone thinking they want to kill themself to actually doing it. And more data is coming.
This spring, the Canadian Institute for Health Information (CIHI) will release data on self-harm and suicide for the first time. It’s a very welcome advance, says Rice. “I think that will be a very important baseline.”
The data is part of a four-year plan to fill “important data gaps” identified by federal, provincial and territorial governments in 2018.
Last spring, CIHI released the first set of new data, revealing that more than 400 Canadians are hospitalized every year because of alcohol or drugs and that nearly half of those people have a mental health condition like anxiety, depression or schizophrenia.
“I’m hopeful that the new indicator by CIHI will be a jumping-off point to start getting a more holistic picture,” says Rice.
While new data is good, Dr. Mark Sinyor, a psychiatrist at Sunnybrook Health Sciences Centre and vice-president of the board of the Canadian Association for Suicide Prevention, says we know enough now to help people.
“We have a lot of data on which treatments and interventions, both at individual and population level, work,” he says.
Sinyor doesn’t think the focus should be on trying to predict who, exactly, is going to die by suicide.
“There’s no history within any medical specialty of being able to do that,” he says.
“Rather than trying to predict the future, which is notoriously difficult to do, we know people who are at risk for suicide and we should be giving all of them outstanding care and preventions.”
But access to care and prevention often isn’t easy to come by.
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Last fall, children’s advocates across the country released a research paper on youth suicide and called for the creation of a national strategy to cope with the epidemic (Canada is in the top five for youth suicide rates internationally).
Around the same time, Children’s Mental Health Ontario (CMHO) released a report that found many young people are waiting more than a year to access service, a delay that impacts their caregivers and, in turn, the economy to the tune of more than $400 million for absenteeism and loss of work.
Earlier this week, CMHO released another report, this one critiquing the doubling of wait times for children and youth mental health services. Some 28,000 young people are on the waitlist, the report says, up from roughly 12,000 in 2017.
“It’s frustrating from a service provider’s perspective,” CMHO’s CEO Kimberly Moran told The Canadian Press.
“They understand that when we wait, kids can get more ill and they watch that happen … and I think families are just outraged that they have to wait this long.”
Still, Sinyor wants people to stay hopeful.
“There’s no reason anyone has to die by suicide,” he says.
If you or someone you know is in crisis and needs help, resources are available. In case of an emergency, please call 911 for immediate help.
The Canadian Association for Suicide Prevention, Depression Hurts, Kids Help Phone 1-800-668-6868, and the Trans Lifeline 1-877-330-6366 all offer ways of getting help if you, or someone you know, may be suffering from mental health issues.