Tag Archives: Teens

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.

Youth Violence

Dr David Laing Dawson

Four teenage boys were murdered in Toronto in the last few days. One was killed inside his school with a knife. An eighteen year-old was killed by gun(s) in a back alley, possibly by a group of four other young men. And two boys lost their lives by gunshot while either observing or participating in a large social-media planned fight between rival schools.

Each of the candidates for mayor of Toronto has been pushed to address the problem of youth violence. Each has tried in their own way. Mr. Ford by talking about all he has done for youth in the past. Mr. Tory by promising money and programs. Ms. Chow by talking about poverty.

CBC interviewed youth workers and counselors. Each promoted an expansion of what they are doing now. Each was understandably distraught and a little angry about these killings. As we all are.

But before we throw money at the problem, or promote our favored panaceas, or recommend the unlikely and impossible, might it not be wise to study these cases? Let the police do their job and then look closely at each event (and possibly a few others). Hire two social scientists to cull the information, interview people, and come to an understanding of each story. Give them a deadline and task them with finding any elements in the chain of events that led to these deaths that could have been interrupted. And do we have the tools and means to do so?

There may be no commonalities to these deaths. The stabbing inside the school is inexplicable so far (untreated mental illness?). The back alley killing smells of gangs and drugs and retribution. The killings in the park sound like a group beef between teenage boys (over a girl, some disrespect, a perceived slight, a territorial infringement?). This last would not be a new phenomenon, but today fueled and expanded by Twitter and Facebook, and at least one boy brought a gun to what should have been a taunting stand-off, words and puffery, or, at worst, a fist fight.

But lets look at these events closely, study them. Are there any common elements? Are there preventable elements? And only then ask the question: What tools and programs and incentives are needed to bring about this prevention?

Dr Dawson is a child and adolescent psychiatrist and author of The Adolescent Owners’ Manual