By Dr David Laing Dawson
Marvin and I have written blogs about the failure of current and proposed “suicide prevention programs”, the crisis line, the gatekeeper programs, the public awareness programs. He points out these programs make us feel like we are doing something, at least, but are a waste of money.
I would go further. I think they actually increase the number of people who use “suicide threats” as negotiating tools, and then through the intervention of family, counselors, and teachers find themselves in the Emergency Department of Hospitals being assessed by nurses, emergency doctors, social workers, and often the psychiatrist-on-call over a three hour to three-day period. This uses up our resources and poses the risk of inuring these front-line professionals to true suicide risk.
The number of people who actually kill themselves each year is remarkably stable. We know it goes down in wartime, increases in peacetime, and poor economic times. We know the demographics of suicide. We know the high-risk groups.
We know that a few of these suicides constitute rational, understandable, reasonable, sane and logical decisions to end one’s suffering in the face of incurable disease and disability. Hence the current move toward allowing some physician assisted suicides.
We also know that the suicide of someone in other circumstances (temporary distress, intoxication, treatable illness) can be devastating to family and friends. It may in fact be an event from which a sibling, a parent, a child never fully recovers.
We know that many social factors put people at higher risk:
- inadequate housing,
- inadequate support systems,
- social isolation,
These factors have no simple solutions but can be gradually improved through well-funded social programs, retraining programs, affordable housing.
We also know that many suicides occur in the population suffering from severe mental illness especially when:
- Discharged from hospital prematurely,
- Unable to be hospitalized in a timely fashion,
- Drop out of treatment or go off medication,
- Their illnesses are not identified nor adequately treated.
We also know a particularly tragic circumstance is the suicide of a teenager, often responding on impulse to something they see as catastrophic, life impairing, hopeless, even while we adults know the situation is transient and will get better.
So what should we do if we want to spend our money on programs that will ultimately make a difference to that completed suicide statistic?
I don’t think I can answer my own question in a blog, but I can start a grounded discussion.
- Easy access to family friendly mental health resources including hospital beds.
- Hospitals return to somewhat longer hospitalizations with discharge waiting until true stabilization and a good discharge plan. Stop the fast turnover and length of stay pressure.
- Better comprehensive outpatient programs for the seriously mentally ill (including PTSD), ensuring the best possible treatment and compliance with that treatment.
- Training, organization of services, physical environments that allow optimal detection and response to depression, anxiety and psychosis by family physicians and emergency doctors.
- Continue improving our alcohol and addiction programs.
- If there are to be government sponsored public education programs they need to counter the very loud voices denying the existence of mental illness, and denigrating medical treatment. They need to focus on parents monitoring their adolescents’ online activity. They need to focus on parents ensuring their adolescent does not have access to lethal weapons and substances.
As for the horribly high rate of suicides on our reserves and among our first nation peoples: I do not think they suffer from a higher rate of actual mental illness than the rest of our country. But all those social factors that increase risk are ubiquitous on many reserves:
- Alcohol and drug abuse
- Poor housing
- Severe unemployment and underemployment
- Poor rate of attendance and completion of school.
- Easy access to lethal weapons and lethal drugs.
- Social disintegration and corruption.
- The hopelessness and anger fueled by dependency.
We should study the reserves that are successful, and then work with the leadership of the first nations people to recreate these factors within less successful reserves. Throwing money at the problem does not help. Sending in more “mental health professionals” does not help. Responding to political whims and self-serving demands does not help. We need to help the leadership of these reserves find clear-eyed solutions or improvements to each of the social problems listed above.