Health Committee on March 8th, 2012

[The Chair, Conservative, Joy Smith]

Ladies and gentlemen, I ask you to please take your seats. We're right on time, but we have a lot of very important information to go through today.

I'm going to introduce to you, from the Canadian Association for Suicide Prevention, Ms. Dammy Damstrom-Albach. She is the president. Welcome.

We have Ms. Jennifer Fodden. She is from the Lesbian Gay Bi Trans Youth Line. Welcome.

From the University of Western Ontario, we have Dr. Marnin Heisel, associate professor and research scientist, Department of Psychiatry. He is running late. His plane will be landing shortly, so he'll be joining us in a little while.

As an individual, we have Dr. Brian Mishara, director of the Centre for Research and Intervention on Suicide and Euthanasia. Welcome.

And I want to welcome a very good friend of ours, Ms. Denise Batters, the wife of Dave Batters, one of our members who was with us a few years ago.

We are going to begin with Ms. Dammy Damstrom-Albach, please.

[Dammy Damstrom-Albach, President, Canadian Association for Suicide Prevention]

Good morning, and thank you very much for allowing me to address the committee.

As you are by now well aware, as many as 10 Canadians die each day by suicide, and these mostly preventable deaths devastate the lives of so many others. On that basis alone, our government should play a significant role in suicide prevention. However, this role and the government's response to suicide must be in keeping not only with the seriousness but also with the breadth and the complexities of this issue.

This requires an approach that is authentic, multi-faceted, and nuanced, an approach specific to suicide prevention, intervention, and “postvention”, which of necessity focuses particular attention and action beyond simple inclusion in a broader initiative. Positive outcomes demonstrating our government's true commitment to suicide prevention depend upon specific, comprehensive, and concrete action, and eventually upon appropriate funding as well. While we understand funding for suicide prevention is not part of today's discussion and cannot be tied to a private member's bill, we all appreciate that it must at some point enter in.

Bill C-300 is a first step. Because of this bill, as well as that tabled by Megan Leslie and the recent motion put forward by Bob Rae, Parliament at last has broken its silence on suicide to join in a national conversation. We are very grateful for that.

However, I believe we owe it to Canadians to figure out what it will take to do this right. We must use this bill as a compass to chart our best direction, not take half measures. We know parliamentarians of every stripe are deeply concerned, and many have been personally touched by suicide in some way, as we saw last October when so many spoke of the tragedy of suicide and the need for bold action.

We are told that for every suicide death, there are at least 10 close others whose lives are profoundly impacted. That is 100 Canadians every day. Think about what that means over a decade. Many of these survivors suffer in silence and may themselves become vulnerable to suicide, particularly without compassionate and knowledgeable care and support.

Yet suicides are for the most part preventable. There are solutions, though they are rarely quick or simple. Suicide prevention in Canada is fragmented. The work began with dedicated individuals and small organizations scattered all across the country, and this remains reflected in our current state. There is no national vision unifying our efforts and few mechanisms that allow us to learn from and build on our knowledge and experience. At times, knowledge is confined to special interest or otherwise privileged groups and not easily accessible or transferable to grassroots organizations, front-line workers, and survivors.

When it comes to suicide prevention in Canada, the right hand often does not know what the left hand is doing, even though there are investments being made and great things being done in pockets all across the country. Because of this, good investments can fail to have broad impact, and their usefulness is then diminished.

Indeed, our government has made some focused investments in suicide prevention, but there is no structure to facilitate benefits spreading to all the places where they could be useful. A case in point is the recent announcement by the federal Minister of Health regarding a $300,000 grant to research best practices. This decision was made with the very best of intentions. However, in the absence of a framework and coordinating body, the government was unaware that similar exercises had taken place in other countries and that in 2003 the Canadian Institutes of Health Research had commissioned Dr. Jennifer White to undertake a Canadian suicide research review. This report identified substantial Canadian contributions to the suicide knowledge base and identified important research gaps. Hopefully, the upcoming research will build on Dr. White's 2003 report. In fact, an update of this report, with the addition of the global picture from similar recent reviews, would likely have been more sensible, along with funds directed to addressing some of the gaps already identified.

The assumption that simply making gathered knowledge available means that it will be swiftly put into action ignores the transitional steps needed to turn evidence-based knowledge into useful, practical application. Furthermore, the rapid gathering of this information could have been done in a few weeks by a simple request to SIEC, the Suicide Information and Education Centre, and to Crise to provide the latest material compiled across the globe.

We may well be spending $300,000 to reinvent the wheel. The government cannot be faulted, because there is no structure or appointed body to inform such decisions, nor is there any such structure to ensure that stakeholders across Canada have equal access to gathered information and the capacity to translate it into policy, implement it in practice, and then evaluate the outcome and feed the results back to others who need to learn from them.

This is where the federal government comes in. It is not a small role that the government must assume. It must function as both catalyst and glue to stimulate and cement the needed connections. Suicide prevention requires all levels of government to unite in support of the community groups, survivors, those with lived experience, and the thousands of volunteers who have long done the lion's share of this work. The national government must step forward to do its portion.

The federal government can also address fragmentation by honouring the 1996 UN guidelines on suicide prevention. Surely Canada's approach must be consistent with these guidelines, which clearly state that the litmus test of a country's commitment to suicide prevention is the appointing of a national coordinating body to promote collaboration and collective action and regularly report on progress.

Let us take full advantage of the wonderful opportunity we've been given thanks to the non-partisan leadership of people like Harold Albrecht, Megan Leslie, and Bob Rae. Bill C-300 is a good beginning. However, we need to extend our reach to be sure we do all that we can do for those Canadians whose lives have been or may be touched by suicide. Bill C-300 recognizes that suicide is a public health priority; however, it places most of its emphasis on knowledge exchange.

While this is one essential element of a comprehensive approach, knowledge exchange cannot stand alone. At a minimum, we must also consider establishing a national implementation support team to advance a comprehensive federal, provincial, territorial, public, and private response to suicide prevention. We must develop policies aimed at reducing access to lethal means. We must create guidelines and action initiatives to improve public awareness, knowledge, education, and training about suicide. And we must support an enhanced information system to disseminate information about suicide and suicide prevention.

[The Chair, Conservative, Joy Smith]

I have to ask you to wrap up because you're over your time.

[Dammy Damstrom-Albach]

Clearly, all of the things that CASP is hoping for will require funding, sufficient funds to transform our compassion into action. Our action must be guided by research evidence, practice, and lived experience, and it must be informed by current Canadian data about suicide rates, trends, and risks.

[The Chair, Conservative, Joy Smith]

Thank you. I'm sorry.

We'll have to go now to Ms. Jennifer Fodden.

[Jennifer Fodden, Executive Director, Lesbian Gay Bi Trans Youth Line]

Thank you to the members of the Standing Committee on Health for inviting me to provide testimony this morning.

I appreciate the opportunity to highlight for the committee the particular perspective of lesbian, gay, bisexual, transgender, transsexual, and two-spirit people, which I will hereafter refer to as LGBT for brevity's sake, and our community's relationship with the ideas being discussed today, suicide and suicide prevention.

There are many factors that contribute to a person's risk of suicide ideation and attempts, and while many of these are individual factors, there are also special populations of people that research and experience have shown to be more likely to contemplate, to attempt, and, sadly, to succeed at taking their own lives.

First nations and Inuit peoples and LGBT people represent two of the communities at greatly disproportionate risk relative to the general population. I urge the committee to seek to understand the unique and important factors that affect first nations and Inuit peoples at your next session. Today, I will attempt to present to you the sad reality of the impact of suicide on my community of LGBT people.

I'll begin with a bit of background about myself. I have a master's degree in counselling psychology and I have worked in child and adolescent mental health for 12 years. I'm the executive director of the Lesbian Gay Bi Trans Youth Line. We provide peer support services to youth aged 26 and under throughout the province of Ontario. We serve approximately 6,000 youth each year, providing online and telephone listening, support, information and access to local resources whenever possible. Our services are provided by highly trained youth volunteers who themselves identify as members of the LGBT community.

We do not provide crisis services per se, but the work we do is suicide prevention work at its heart. We provide relief from isolation and we provide acceptance and non-judgmental listening. We provide access to community. Even if it's communicated just by a voice on the phone or an online chat window, it offers a glimpse of hope that can have a significant impact on those who are reaching out.

I want to emphasize for you today the profound ways that the LGBT community is affected by suicide. I have drawn from a number of reliable and peer-reviewed research resources for this presentation today. I will happily share these with the clerk's office if the committee would like access to them after today's meeting.

I'll not overwhelm you with statistics, but I will put before you some of the most stark and revealing numbers. Meta-analysis studies have found that sexual minority individuals were two and a half times more likely than heterosexuals to have attempted suicide. A recent Canadian study estimated that the risk of suicide among LGB youth is 14 times higher than for their heterosexual peers. A large and statistically representative study of trans people in Ontario found that 77% had seriously considered suicide and 45% had attempted suicide. Trans youth were found to be at greatest risk of suicide, as were those who had experienced physical or sexual assault.

What can explain these staggering figures? I want to impress upon the committee that it is not the fact of being lesbian, gay, bisexual, trans, or two-spirit that imposes these risks upon a person's psychological well-being. Rather, it is being a member of a group that experiences oppression, exclusion, omission, and hate that leads to this sad reality.

LGBT people experience stigma and discrimination, and this stigma can have a variety of negative consequences throughout their life span. LGBT people are also targets of sexual and physical assault, harassment, and hate crimes. These pressures, as well as the stress of sometimes concealing one's orientation or modifying behaviour or appearance in anticipation of homophobia and violence, have a negative effect on mental and physical health. Family rejection in adolescence has been linked to increased substance use, depression, and attempted suicide.

Trans people experience even more significant social marginalization in our society. For many who cannot pass as cisgender, or non-trans, the added visibility leaves them more susceptible to harassment and abuse. The cumulative impact of erasure, pathologization, and exclusion leave trans people, and trans youth in particular, vulnerable to suicide. That is what research has been able to demonstrate.

But not all of this is a surprise to those of us in this room. In recent months and years, there have been many stories that have captured the attention of our country's media and viewers at home. There have been stories of young lives ended, just when they ought to be getting started. We have heard tell of homophobic bullying and tormenting that has taken place in schools and online among university students and pre-teens. We have seen video clips filmed by bright and talented young people full of spark whose will to go on has been broken.

As a community, we grieve each of these losses deeply and sincerely. We know that for every one of these LGBT lives lost, there are many more whose stories won't be told because they've taken their secret pain to the grave.

At the Lesbian Gay Bi Trans Youth Line it is not uncommon for our callers to speak about times they had attempted but somehow, thankfully, fallen short of succeeding and ending their lives, and more common still to hear contemplations. Ending it all can seem a very real option to far too many of our kids.

This all sounds very bleak, and indeed it paints a picture of communities in crisis. It is stories like these that have brought us all here today to undertake the important work of making suicide prevention a priority for all, a matter of public health and safety.

The bill before the committee proposes many helpful elements, and I congratulate the authors on some of the following elements in particular. Paragraph 1 of the preamble specifically outlines that suicide “can be influenced by societal attitudes and conditions”, which is the very essence of what I am presenting to you today.

I put to you that you should consider naming the societal attitudes that you refer to in this paragraph more directly: homophobia, transphobia, and racism. Alternatively, naming the communities and populations that are known to be disproportionately affected by this issue could strengthen the impact of this bill.

I offer strong support for paragraphs 3 and 4 of the preamble, particularly the naming of communities as agents of action in both the prevention of suicide and after care of survivors impacted by suicide.

I stand firmly behind the use of knowledge transfer and exchange as mechanisms for change in our public attitude toward suicide, and I urge the government to utilize the research and resources that are available from sources such as Rainbow Health Ontario and Trans PULSE to inform the tools and resources that this bill will stimulate so that the concerns and realities of LGBT individuals and communities are made visible to the general population.

Finally, I urge the committee to look not only to research bodies but also to communities as sources of valuable information, healing, and prevention. Building communities of, with, and for our most vulnerable people can provide the safety net that will ensure LGBT individuals do not become statistics.

Thank you.

[The Chair, Conservative, Joy Smith]

Right on time. How did you ever do that? Thank you so very much.

Now we'll go to Denise Batters.

Denise, is your video ready to go now? Okay.

All the members do have transcripts. We will begin, then.

[Video Presentation]

[The Chair, Conservative, Joy Smith]

Thank you for coming today. It's going to help a lot of people.

[Denise Batters, As an Individual]

Thank you. It's wonderful to be here.

Good morning, Madam Chair and committee members. I'm so honoured to be here today.

That news story played last month throughout Saskatchewan on Bell's “Let's Talk Day”. You saw a quick synopsis of why I find myself here today, but here is a little more of my story.

My husband, Dave Batters, and I first met in 1989, in Saskatoon, crossing the street at a political convention. Dave was first elected as the federal member of Parliament for Palliser in June 2004, and he was re-elected in 2006. In fact, Dave was a member of this very committee in his second term in office.

In 2008 Dave became quite ill with severe anxiety and depression. He also overcame a dependency on his prescription medication used to reduce his anxiety and help him sleep.

Shortly before the federal election was called in September 2008, Dave announced he would not run for re-election. He publicly announced why, disclosing the battle he had been waging.

In his words, taken from his press release, he said:

I make this very personal disclosure with the hope that others who suffer from these conditions will seek the assistance they need. There is still a stigma attached to such illnesses and I want to make sure people realize these are conditions that can strike anyone and need to be treated.

Tragically, Dave took his own life on June 29, 2009. Taking a cue from his openness about his illness, we issued a press release disclosing that, sadly, Dave had died by suicide.

Prime Minister Stephen Harper attended Dave's funeral and gave a very important speech. He not only described some of Dave's great personal qualities that made him a valued friend and colleague in the caucus, but he also talked about depression and suicide. One of the most fitting lines of this speech was this:

Depression can strike the sturdiest of souls. It cares not how much you have achieved or how much you have to live for.

In 2010 we held a golf tournament in Dave's memory. I wanted to have the money raised go to a cause that might help someone like Dave. I wanted to produce a TV commercial that targets men between 30 and 50 years old suffering from anxiety and depression. Our golf tournament raised $20,000, and we produced that TV commercial, which ran in Saskatchewan for many weeks. This 30-second ad is still available on YouTube; just search “Dave Batters”. Please view it there and post the link on your Facebook and Twitter pages. I would love to get the number of hits up on this very important message of awareness.

In the Prime Minister's video message sent to our golf tournament, he said:

By publicly revealing his struggle with anxiety and depression, Dave reminded everyone who suffers from mental illness that they are not alone. This is a message that needs to be heard, not just by victims of mental illness, but by everyone, to deepen the well of understanding and support for those battling this disease. This is Dave Batters' legacy.

Many men suffering with severe anxiety and depression think they are alone in their suffering. They think no one else could possibly have felt like this before. We must let them know they are not alone.

Also, many of these people feel they are a huge burden to everyone, and everyone would be better off without them. That is why so many of them resort to this final choice. They need to know their family and friends want to help and don't consider them to be a burden. For those of us now without those loved ones in our lives, we would do anything we could to have them back with us.

Soon after Dave died in June 2009, my counsellor warned me not to get involved with a cause too soon. He knew invitations to get involved would come early and often for me, given my openness about Dave's suicide. That was good advice. But in 2010, when Dave's friends approached me about the golf tournament, the time seemed right for a cause.

I think my difficult journey has been assisted because I was open that Dave had died by suicide. So many people feel that the stigmatized nature of suicide prevents them from discussing the death of their loved one. Some deny the cause of death, or even lie about it. Everyone goes through their own grieving process, and with suicide there are so many difficult and conflicting emotions involved for the bereaved.

I want to talk about Dave, particularly with people who knew him and loved him. I have had many people say to me, “I wasn't sure if I should mention Dave to you, because I thought that might be painful for you.” However, there is nothing that brightens my day more than hearing a new story about Dave. He was such a funny, friendly person. He deserves to be remembered often for all of those great qualities.

Madam Chair and committee members, from my personal perspective, when I look at Mr. Albrecht's bill, these are the two most important aspects of it: the stated goal for increased public awareness and knowledge about suicide, and the federal framework that promotes consultations and collaboration on this urgent health issue all across Canada.

There are many outstanding groups doing good work in pockets across the country. There's a great need for better coordination of these efforts. I believe this will help to give the most important thing of all: hope to Canadians like Dave.

Thank you very much.

[The Chair, Conservative, Joy Smith]

Thank you very much, Denise.

Dr. Mishara, thank you for joining us. Please give us your presentation. You have seven minutes.

[Prof. Brian Mishara, Director, Centre for Research and Intervention on Suicide and Euthanasia, Université du Québec à Montréal, As an Individual]

I'm going to speak in French, if that is all right.

In 1987, the report of the National Task Force on Suicide in Canada provided in its conclusion a series of 40 specific recommendations to prevent suicide in Canada. I was part of the group of experts tasked with revising and updating that first report from the group of experts. Health Canada issued that new version in 1994. Seven years later, we could only reiterate the same 40 recommendations because nothing had been done. Since then, none of the 40 recommendations have been implemented.

Today, close to 30 countries have a national suicide prevention strategy, and the WHO recommends that all countries develop one.

I'm a researcher. Research shows that national strategies have an impact on suicide. For example, a study published in 2011 in Social Science and Medicine focused on the suicide rate in 21 countries between 1980 and 2004. In those 25 years, the suicide rate dropped each year by 1,384 out of 100,000 residents, or by 6.6% a year. According to the study, if Canada, with a population of 34 million, had a national strategy like that of other countries, the number of deaths by suicide would decrease by 476. If we consider the financial impact of health and mental health care and the psychological and emotional impact of deaths by suicide, the possibility of saving 476 lives a year may justify major investments in suicide prevention.

Bill C-300 is a good start and indicates that Canada wants to be among a growing number of countries that have invested in a national suicide prevention program. A number of Canadian provinces have already made great strides. In 1998, Quebec created the Stratégie québécoise d'action face au suicide. Between 1998 and 2008, there was a decrease in the suicide rate for all age groups. The rate for youths in Quebec dropped by half compared with 1998.

Certainly, the provinces have a responsibility when it comes to health and mental health. Suicide prevention is part of that. But significant steps at the federal level can contribute considerably to decreasing the suicide rate in Canada. Think about the medication that causes the most deaths by suicide: it's acetaminophen, Tylenol, which is available over the counter in large quantities. In England and in a number of other European countries, a simple regulation aimed at controlling the quantity of pills in a single container that a person can purchase resulted in a lower number of poisonings, whether intentional or unintentional, caused by this medication. The fact that fewer dangerous medications are available at home has reduced the risk for suicidal individuals. This kind of policy doesn't cost the government anything and offers an increased probability of saving lives.

Other examples of possible actions that can be taken at the federal level include media awareness, particularly on the impact their reports have on suicide. This impact has been very well documented through a significant body of research. Encouraging early intervention to promote mental health in young people is another example.

The spirit of Bill C-300 is commendable, but the repercussions of this kind of legislation will be determined by the resources available to implement it and how the authorities, which are called relevant entities within the Government of Canada, will invest competent resources to carry out the tasks set out in the legislation.

This bill is very different from the national suicide prevention strategies elsewhere in the world that have had a considerable impact on the suicide rate. The national strategies that have been successful have not given an existing entity the mandate of dealing with suicide prevention; instead, they have created a governmental or paragovernmental organization responsible for the strategy.

Those entities had sufficient funding to interact with the provincial, governmental and non-governmental authorities to develop a concerted action on suicide prevention. However, all the strategies that have been successful received good funding from governments for pilot projects, monitoring and various activities.

Without specific funding allocated to suicide prevention, Bill C-300 risks having the same impact as the report entitled Suicide in Canada and the updated report. It was a lot of fine words, but the federal government has taken almost no action in terms of suicide prevention.

Canada has an enormous amount of suicide prevention resources. We are exporters of knowledge in this area. Our research is often used elsewhere. We can learn from the success and experiences at the provincial and local level, but the federal government also has a role to play, as I have already mentioned. I'll repeat that the government just wasted $300,000 to draft existing documents, which have been written recently elsewhere in the world. Lack of coordination seems to be a common occurrence.

Instead of palming the mandate off on a relevant entity within the Government of Canada, I recommend that the bill be amended to create a governmental authority that would be responsible for implementing the legislation. I also recommend adding that this entity make recommendations on changes to Canada's legislation, policies and practices to encourage a decrease in suicide.

Furthermore, I find that the timeframe suggested, which provides for an initial report in four years, must be replaced and that an annual report should be requested. I know that it takes time to establish a strategy. However, other countries in the world have generally taken one or two years to create a national strategy that has involved thousands of stakeholders, given the small amount—

[The Chair, Conservative, Joy Smith]

I'm sorry, sir, you're over time and I have to ask you to wrap up. Thank you.

[Prof. Brian Mishara]

I don't see any reason why we can't start implementing this legislation in Canada in under two years.

[The Chair, Conservative, Joy Smith]

Thank you so very much.

Now we'll go to our seven-minute Qs and As, and we'll begin with Ms. Davies.

[Libby Davies, NDP, Vancouver East, BC]

Thank you, Chairperson, and my thanks to all the witnesses for being here today.

This is our second meeting on this important issue, and I think we all feel compelled from the testimony we've heard to take much stronger action.

Ms. Batters, thank you for coming and for being so courageous in sharing the experience you went through. I know it's not easy to speak out. I think there is a notion out there that MPs live in this other world, and that we're not connected. For you to be able to explain what happened to Dave and describe how we all suffer from the same ailments, conditions, and mental health issues as the general population helps to connect us with our community and our broader society. I want to thank you for how forthright you've been.

A couple of questions come to mind. To you, Mrs. Batters, who have dealt with this issue publicly, I wonder if you could say a little more about what you think is the immediate first step. We're aware of the stigma. We're aware of how hard it is sometimes for people to come forward to seek the help they need. From what you've learned in working with people, how do you see that important first step? How can we reinforce that in our local communities?

I'll also add another question about whether we need a new national coordinating body. Ms. Albach, you spoke about the UN guidelines and the need for a national coordinating body. I'm curious to know how that works with the Mental Health Commission. We do have the Canadian Mental Health Commission. We hear they're coming out with a strategy in a few months. How do these two things fit together? Do we need a separate entity in Canada that will undertake this, or is this something that's part of the commission's coordination and works?

Those are my two questions. I'd like to begin with Mrs. Batters.

[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?

[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.

[The Chair, Conservative, Joy Smith]

Thank you so much for your comments.

[Libby Davies, NDP, Vancouver East, BC]

Do I have more time?

[The Chair, Conservative, 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.

[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—

[The Chair, Conservative, Joy Smith]

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

Thank you.

[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.

[The Chair, Conservative, 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.

[Colin Carrie, Conservative, 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.