By Dr David Laing Dawson MD
A Five Part Series
1. Background (Reality)
Over the last 20 to 30 years we have all witnessed an increasing emphasis on “suicide prevention”. This has included TV spots, public health announcements, and the development of crisis lines. Most major emergency departments now have some form of mental health team available to them. Many police departments now have mental health teams, psychiatric nurses, or social workers working with them. All doctors, mental health workers, school counselors, school nurses have been encouraged to ask the question. The phrase “suicide ideation” has become part of our popular jargon.
Fair enough. Though some suicides result from competent and rational choices to end one’s suffering from incurable disease, many others are tragic, tragic both to the victim and his or her survivors. And it always seems even more tragic when the victim is young and the suicide unexpected or unfathomable.
One of the obvious results of this heightened awareness of suicide, “suicide ideation”, and the behaviours that are called “suicide attempts”, has been a dramatic increase in the numbers of people seen in emergency departments for the identified problem of “suicide ideation.”
Below are four graphs showing just how dramatic this increase has been. An increase of 11 to 14 percent per year for six years is quite astonishing. These are American figures but I am sure the trend would be the same in Canada.
From: HCUP Overview. Healthcare Cost and Utilization Project (HCUP). April 2017. Agency for Healthcare Research and Quality
Now, at first glance this would imply that the new “awareness” and alertness with regard to suicide, and especially suicide ideation, is working. It means, doesn’t it, that far more people are being identified as “at risk” and coming to, or being brought for, an emergency assessment. Which in turn would mean that the actual suicide rate should be declining.
But it isn’t.
The suicide rate in Canada for the years 1950 to 1960 averaged about 7.5 deaths per 100,000 people.
The suicide rate in Canada for the years 2000 to 2009 averaged about 12 deaths per 100,000 people.
In the United States the suicide rate increased 24% between 1999 and 2014 to 13 deaths per 100,000.
I cannot scientifically claim there is a cause-effect relationship here, only an association, but I can certainly claim that the awareness of and the alertness to “suicidal ideation” has NOT decreased the rate of actual suicide in any age group.
But I do think that by focusing on, advertising, talking relentlessly about, “suicidal ideation” we have dramatically increased the use of “suicidal thinking” and suicidal threats as interpersonal negotiating tools, while making no difference to, and certainly not preventing, actual suicides.
What we have been doing is not working. It may even be exacerbating the problem. Yet every month or two I hear more of the same being promoted. We have not reduced, we may even have increased, the incidence of the very personal and often tragic act of suicide. And we may have simply caused or grown another public health problem unnecessarily straining our resources.
(continued in parts II through V)