On the Efficacy of Suicide Prevention

David Laing DawsonBy Dr David Laing Dawson

In the past decade, make that two decades, we have witnessed a plethora of mission statements, lectures, programs, public health campaigns, TV ads, crisis services, anonymous telephone answering services, crisis lines, websites, information initiatives, task forces, white papers, all aimed at suicide, reducing the suicide rate in our communities, preventing suicide.

Yet the rate of suicides in Canada, completed suicides, remains statistically unchanged.

All of the above activities make us feel we are doing something about the problem. We are trying. But that is all they do.

The problem with a public campaign to prevent suicides is that it is akin to a public campaign to prevent heart failure. Both are end stages of other processes, but in the case of heart failure we know enough to target smoking, cardiovascular disease, obesity, hypertension, diabetes, rather than “heart failure”. We do not say, “Call this number if your heart is failing.”

We know the demographics of completed suicide. We know the risk factors. We know the specific and usually treatable illnesses that all too frequently lead to suicide. So if we truly want to reduce the actual numbers of people who kill themselves (not threats, small overdoses, passing considerations), then we need to stop wasting resources on “suicide prevention programs” and put them into the detection and treatment of those specific conditions so often responsible for suicide:

  • Some suicides are bona fide existential decisions, a choice to end one’s life of suffering: terminal illness, intractable pain, total incapacity.
  • Some suicides are the result of chronic complex social factors: unemployment, divorce, poverty, loss, alcoholism, addictions, isolation, and chronic illness. We can chip away at these factors with better support and rehabilitation services, improved minimum wage, retraining – but there is nothing we can do quickly and easily.
  • Some youth suicides are the result of impulsivity, intoxication, and an available instrument of death. Impulsivity comes with youth. Parents can keep an eye on intoxication. But we can make sure no instruments of death are available. Guns. Pills. Cars. Get rid of the gun(s) in the house. Lock up the serious drugs. Driving the family car is a privilege, not a right.
  • Some teen suicides today are the result of public shaming, bullying. Watch for this. Chaperone the parties. Monitor Facebook, Snapchat. No cell phones or internet in the child’s bedroom. It bears repeating: NO cell phones or internet in the child’s bedroom.
  • And then we have the specific mental illnesses that all too frequently, especially when undetected or under-treated, lead to suicide. These are Depression, Schizophrenia, Bipolar Disease, Severe Anxiety, PTSD, and OCD. And if we really want to make a dent in that suicide statistic then our programs, our money, our resources, should be directed to detection, comprehensive treatment, and monitoring of these illnesses.
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5 thoughts on “On the Efficacy of Suicide Prevention

  1. You continue to astound me Dr Dawson with your grounded analyses and understanding. You have such a rational approach based upon evidence and expose the truth that the system does not wish to face. In this case it is in needing to feel it is doing something. Much as a GP automatically prescribing antidepressants. The whole system is wracked with this pseudo interventionism or with denial. Little wonder it is failing so catastrophically.

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    1. His analysis comes from hard years of experience and an honest approach to reality and what is dished up as fact when it is really nothing to do with facts. When those who are steeped in bad policy they create new mission statements and new visions. These activities have little to do with improved care and appropriate service delivery . It is shocking to see the mess that these policy makers. The make workers !

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  2. With respect, you omitted the only way to eradicate brain diseases like schizophrenia, depression, autism and the many other chronic brain diseases is like any other medical disease–scientific cause and cure research.

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  3. Thank you Dr. Dawson for churning through the hypocrisy and targeting the root causes of suicide. Like you, I am fed up with all the hype about “mental health reform” and examples of it like “stigma campaigns” or “suicide prevention campaigns”. Some of this is coming from self declared “advocates”, pulling in one or more “sunshine list” salaries, yet the so called ‘beneficiaries” sit in homeless shelters, as my relative is now, often with untreated or undertreated mental illness. There needs to be a redistribution of power within the so called “mental health system” so that all stakeholders have a voice.. One way this could happen is to implement the Mental Health Commission of Canada’s Family Guidelines.The implementation of these Guidelines would address long standing issues of frustration for families and can be demonstrated to make a difference. For example, the Guidelines recommend a “cultural shift” towards serving “the client and the family” which gives the service provider more flexibility in approaching and forming a therapeutic rapport with someone who does not believe that he is ill. In addition, ways in which to mitigate the negative impact of unrealistic privacy legislation are described, so that both the needs of the relative with mental illness and the care giver are met. Presently, family caregivers “living under the same roof” as their ill relative can be denied needed health information to support the individual. Other areas such as hospital discharge and follow up protocol, the rightful recognition of family caregivers as being part of the healthcare team, and the input of family caregivers in the development and evaluation of services are covered in this document. Recently, I and other family caregivers, reviewed the draft toolkit to implement the Guidelines. The final toolkit will give guidance in how to implement the Guidelines in mental health organizations and hospitals. What we need is commitment from the people who have power in the system to commit to their implementation. Then perhaps, we can all celebrate more accessible mental health care services, better treatment and service, less readmissions to hospitals, better quality of life and savings to the system. Also, there needs to be more effort on the part of the College of Physicians and Surgeons to monitor and enforce accountability of psychiatrists. Yes, there are good psychiatrists, but there are also psychiatrists whose misuse of power is unchecked and causes much harm.

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