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—