Evidence of meeting #33 for Health in the 41st Parliament, 1st Session. (The original version is on Parliament’s site, as are the minutes.) The winning word was dave.

A recording is available from Parliament.

On the agenda

MPs speaking

Also speaking

  • Dammy Damstrom-Albach  President, Canadian Association for Suicide Prevention
  • Jennifer Fodden  Executive Director, Lesbian Gay Bi Trans Youth Line
  • Denise Batters  As an Individual
  • Brian Mishara  Director, Centre for Research and Intervention on Suicide and Euthanasia, Université du Québec à Montréal, As an Individual
  • Marnin Heisel  Associate Professor and Research Scientist, Department of Psychiatry and Department of Epidemiology and Biostatistics, University of Western Ontario
  • Clerk of the Committee  Mrs. Mariane Beaudin

9:20 a.m.

As an Individual

Denise Batters

As to a first step, the reason we made the commercial was to encourage those men who might feel as if they are alone, as if no one else could have possibly felt like this before. The main message at the end of the commercial is that you are not alone. There is help. Please reach out. That might be something as simple as answering the phone when your friends are calling, or it might mean something a little bigger, like making an appointment with a counsellor or a psychologist to help you, or talking to your family doctor about your condition. So there is the awareness.

In recent years, the stigma surrounding depression and mental illness has improved. I think Dave was a trailblazer on that. This was someone who was currently suffering with these things and was a member of Parliament. He issued a press release. He could have just said he was retiring and not explained, but he thought he owed it to his constituents to explain himself. He thought describing what he was going through would help people. That's why he did it, and I took a cue from that. To say that I'm brave in doing this is not true: I took my cue from Dave. He was very brave in what he did. That's why I thought we could be open about the fact that it was suicide.

Does that answer?

9:25 a.m.

President, Canadian Association for Suicide Prevention

Dammy Damstrom-Albach

In response to your question, Libby, I believe that the reason we need a national coordinating body is in order to specifically focus on suicide.

Now, that's not to say that it isn't crucial that we work in cooperation with the Mental Health Commission of Canada, and indeed CASP is certainly doing that.

I think there is one piece that's very important in what I see so far in working with the Mental Health Commission of Canada. Certainly suicide is addressed here and there when you look at the work that's being done to date. But the real concern is that if it's scattered, without particular focus, then it may continue to support the fragmentation that we see all across Canada.

In national strategies that have been most effective—Scotland, the United States, and Ireland are very good examples—we see that they have actually set up a national coordinating body or a national implementation team that works often as an entity under a larger group that's responsible for broader mental health initiatives and mental illness prevention work in a country. But there's specific focus, within that, on suicide that is very particular.

Our concern, certainly, is that whatever work is done needs to fall under the umbrella, perhaps, of the Mental Health Commission of Canada. But it really needs specific focus on suicide because it crosses so many jurisdictions and boundaries. It needs particular focus and I think a particular action plan in order that we can do the kind of preventative work that we need. Also, provide the appropriate supports to people who have been touched by suicide, who have lost loved ones to suicide. Focus on the kinds of intervention that are required, and certainly that includes the support of community wellness. It includes upstream initiatives that support mental well-being, but it also means that we have to intervene more directly with people who are experiencing suicidal ideation, with people who are making suicide attempts.

I almost imagine that it works a little bit like a Russian doll. Perhaps the Mental Health Commission is the largest doll, but there's a suicide prevention focus and strategy and national coordinating body that fits inside that Russian doll, if that metaphor is helpful.

9:25 a.m.

Conservative

The Chair Joy Smith

Thank you so much for your comments.

9:25 a.m.

NDP

Libby Davies Vancouver East, BC

Do I have more time?

9:25 a.m.

Conservative

The Chair Joy Smith

No, I'm sorry, Ms. Davies.

Joining us now is Dr. Heisel, who has made a valiant attempt to be here on committee, and we want to thank him for that. I'm just going to pause with the questions right now and listen to his seven-minute presentation, and then we'll go to our next member on the list, who is Dr. Carrie.

Dr. Heisel, please.

March 8th, 2012 / 9:25 a.m.

Dr. Marnin Heisel Associate Professor and Research Scientist, Department of Psychiatry and Department of Epidemiology and Biostatistics, University of Western Ontario

Thank you very much.

I apologize for being late and for not having heard my colleagues' presentations. I hope I do not duplicate much.

Honourable members of the standing committee and colleagues, my name is Dr. Marnin Heisel. I'm a clinical psychologist and associate professor at the University of Western Ontario and a research scientist.

My area of research expertise is in the study of suicide and its prevention, with a specific focus on enhancing older-adult psychological resiliency and well-being, improving the psychological assessment and treatment of those at risk for suicide, and developing, disseminating, and evaluating knowledge translation materials regarding late-life suicide prevention.

I'll focus my comments briefly this morning on the potential benefits of creating a viable and sustainable Canadian federal framework for the prevention of suicide, enhancing suicide prevention among Canada's older adults, and highlighting the critical importance of promoting innovation and excellence in the research, development, evaluation, and translation of approaches designed to enhance suicide risk detection and intervention.

According to the WHO, one million lives annually are lost to suicide worldwide. According to Statistics Canada, nearly 4,000 individuals died by suicide in this country in 2008, a figure that we know underestimates the true number lost to suicide but still more than triples the number of those who died by homicide and HIV combined in this country. Far fewer funds are spent on suicide prevention initiatives than on these other important and worthy causes, necessitating a clear response from our federal, provincial, and territorial governments.

Whereas the estimated direct and indirect annual costs of suicide and self-harm in Canada exceeded $2.4 billion in 2004, we cannot put a price tag on the loss of a single human life, let alone on those of thousands. However, we can now all ensure that funds are devoted to creating a sustainable framework for the prevention of suicide for all Canadians.

Suicide is a tragic equalizer. It affects us all, irrespective of age, sex, social class, religion, culture, ethnicity, nation of origin, or sexual orientation. Yet suicide is not distributed equally. Adults over the age of 65 have high rates of suicide and employ lethal means of self-harm, with a high intent to die. Over 6,000 North Americans over the age of 65 die by suicide every year, a number that appears to be increasing with the aging of the baby boomers, a birth cohort exceeding 75 million North Americans and carrying a high lifetime suicide rate.

By 2031, 20% to 25% of all Canadians will be over the age of 65. We're thus now entering an unprecedented period in our history in which a vast population at elevated risk for suicide is reaching a stage of life during which suicide risk is high, and we are not prepared. We do not have a surveillance system in place for detecting or documenting the presence and severity of suicidal thoughts, plans, or behaviour. Our national mortality statistics are incomplete and do not account for provincial differences in the classification of deaths by suicide. Our mental health care system contains numerous gaps through which our most vulnerable routinely fall.

Every year tens of thousands of Canadians join the legions of those of us who have lost loved ones, friends, colleagues, acquaintances, and clients to suicide.

The burgeoning older-adult population will have a dramatic increase in impact on mental health care services for decades to come. Research findings over the last 40 years have consistently shown that up to three-quarters of older adults who died by suicide had seen a family physician or general practitioner in the prior month, and did so significantly more frequently than those who did not die by suicide. The majority of older adults requiring mental health services seek care in primary health care contexts, rather than from mental health specialists. Yet our primary care system was not designed to assess psychopathology or deliver complex mental health care to at-risk older adults.

Multi-centre clinical intervention trials indicate that providing collaborative mental health care to older adults in a primary care medical setting can enhance detection and treatment of depression, increase uptake of mental health services, reduce or resolve thoughts of suicide, and reduce mortality risk. Nevertheless, many primary care providers erroneously believe that depressive symptoms reflect an expected response to age-related transitions and losses, rather than a treatable mental disorder, and neither initiate nor refer at-risk older adults for care.

Clinical guidelines for older adults at risk for suicide recommend interdisciplinary care provision, including access to psychotherapy services and medication where indicated. Unfortunately, many at-risk older adults never receive interdisciplinary care.

In Canada today we lack a sufficient workforce of health care providers trained in gerontology or geriatrics. Geriatric psychiatry is only now receiving recognition as a subspecialty, and geropsychology is at a far earlier stage of development in this country than in the United States. There's a documented need for comprehensive mental health care services for older Canadians and recognition that we have an insufficient body of providers to meet recommended benchmarks for care.

The nature of our mental health system is such that individuals lacking financial resources or extended health care benefits typically cannot access psychological services. In this regard, our American neighbours are in better shape than we are. This is despite the fact that psychological service provision has been shown to create medical cost offsets, reducing or averting usual cost to the health care system.

We must acknowledge that the Canadian mental health care system is two-tiered. Those who can afford private practice services, in addition to those covered by provincial and territorial health care systems, receive far better health care than those who can't. Such social inequity flies in the face of the spirit of universal health care and begs to be rectified.

The field of suicide prevention and research among older adults is in a relatively early stage of development, beginning largely with the study of risk factors. As of 10 to 15 years ago, little data existed on factors protective against suicide risk among older adults or that confer resiliency to suicide in the face of stressors, losses, and other harms. Older adult-specific assessments tools and interventions did not exist.

With research funding from the Canadian government and mental health and suicide prevention foundations, my colleagues and I have begun addressing these gaps. Development of the Canadian federal framework for suicide prevention, dedicated to supporting ongoing knowledge creation and translation can help—

9:35 a.m.

Conservative

The Chair Joy Smith

Dr. Heisel, you're over time, so could you wrap up, please?

Thank you.

9:35 a.m.

Associate Professor and Research Scientist, Department of Psychiatry and Department of Epidemiology and Biostatistics, University of Western Ontario

Dr. Marnin Heisel

Certainly.

Development of the Canadian federal framework for suicide prevention, dedicated to supporting ongoing knowledge creation and translation can help ensure ongoing funding for research focusing on suicide prevention across levels.

Thank you very much.

9:35 a.m.

Conservative

The Chair Joy Smith

I'm very glad that you did make it. Your testimony was very important today.

We'll now go on to our next person, who is Dr. Carrie.

9:35 a.m.

Conservative

Colin Carrie Oshawa, ON

Thank you very much, Madam Chair.

I want to start off by thanking the witnesses for being here for this very important topic. I want to thank Harold for being here, for introducing this bill.

I want to start off, too, by thanking Denise for being here.

I want to thank you particularly for bringing the video. I'm like you. I like seeing Dave. I like hearing his voice.

I think you know we were elected in the same year; we had about the same number of votes that we won by.

9:35 a.m.

As an Individual

Denise Batters

Sometimes people even mistook you for him a little bit, and vice versa.

9:35 a.m.

Conservative

Colin Carrie Oshawa, ON

Actually that is it, and I think that caused Dave a lot of distress. He kept telling me how much better looking he was than I was.

He was a courageous guy. We all miss him.

I want to thank you for your courage, especially about getting the message out. That's what I want to talk to you about first.

How important is it to be open about mental illness, especially with family members?

9:35 a.m.

As an Individual

Denise Batters

I think it's extremely important. It encourages that person who's in this terrible frame of mind to speak about it, and when they start to speak about it, that's likely when help will occur.

As well, I know from different support groups I've been involved in since Dave passed away that it's also very important to be open about the fact that a death is by suicide.

I mean, everyone handles things differently. I've had support group members tell me, “You know, my loved one died a few months before Dave and we lied about it. We said it was a stroke. We said it was a heart attack—something like that. We didn't feel we could properly grieve until we started telling the truth about how that person died.”

I think openness is very important.

9:35 a.m.

Conservative

Colin Carrie Oshawa, ON

Thank you.

I am wondering what advice you would give spouses who have a husband or a wife who suffers from anxiety and depression. How can you communicate to them the warning signs?

9:35 a.m.

As an Individual

Denise Batters

I'm certainly not a doctor, but at the same time it's trying to keep them speaking about it, and open. Isolation is something that draws them further inward and makes them also think there's no other option.

That is the timeframe when usually hope.... As long as you can try to preserve hope. Hope is the main thing for these people. If they have hope, they can go on another day. If they lose hope...you don't have much if you don't have hope.

As far as advice that I would give, keep the communication as open as you can, so that person knows they can speak to you about it and they don't have to feel judged. Especially for men, they're used to being, in a lot of cases, the main salary of the family. They're used to being the ones taking charge. They don't want to feel weak or unmanly.

Like I said in the video, this is not about being weak or unmanly; this is a health issue. To me, it's no different than if you have cancer.