Good evening, committee members. My name is Dr. Allison Crawford. I'm a psychiatrist and the chief medical officer for 9-8-8: Suicide Crisis Helpline. I'm a professor at the University of Toronto and also the principal applicant on a CIHR-funded study examining MAID and suicide in the crisis line context.
I'll be direct. I do not believe Canada should expand MAID to include those whose underlying condition is a mental disorder. I'm basing that on four core points: what we're seeing at 988, the absence of evidence that requests for MAID for mental disorder can be reliably distinguished from suicidal intent, shortcomings of recent clinical guidance, and public health and media risks.
First, on frontline signals from 988, up to 7% of interactions on the service refer to MAID. Critically, among those who reference MAID, 74% endorsed thoughts of suicide in the past two days, compared with 48% among other contacts. In short, interactions with our national suicide crisis line that reference MAID are associated with substantially higher suicidal ideation. That's not a theoretical concern; it's a real, measurable, elevated risk among people who mentioned MAID to Canada's suicide prevention service.
Second, we know that suicidal thoughts and behaviours are very common across psychiatric diagnoses, and they are treatable. Our systematic review of peer-reviewed literature found no credible evidence that suicidal intent can be reliably distinguished from an interest in MAID when the sole underlying condition is a mental disorder. Both suicide and MAID represent an intention to die. Both often stem from the same underlying drivers: psychiatric disorder, intolerable suffering, hopelessness, perceived burdensomeness, and often social adversity. We also found no validated tools or assessment instruments that can reliably discriminate suicidality from a reasoned wish to die in the MAID context.
Third, recent guidance from the Canadian Psychiatric Association does not resolve these clinical or operational gaps. The guidance is largely aspirational. It asks assessors to differentiate acute suicidal risk from a well-considered wish to die, but offers no operational framework, no clear criteria and no specification of structured tools. The guidance also fails to incorporate a standardized equity assessment to determine when social determinants and remediable needs are driving suffering. In practice, this leaves clinicians without the evidence-based procedures needed to safely assess risk or to embed suicide prevention into MAID pathways.
Fourth, there are public health risks in the way that MAID and suicide are discussed publicly and in the media. Our recent research, currently submitted for peer review, highlights that the media often conflates MAID with suicide, or fails to use established, responsible media guidance for reporting on suicide. We lack guidance on safe communication about MAID and on preventing contagion effects, which should be a concern in making MAID for mental disorder an option. As it becomes more visible, the absence of responsible public messaging increases the risk that people will see MAID as a means of alleviating their mental suffering. This will undermine suicide prevention efforts.
Additionally, we must also [Technical difficulty—Editor] all the services across Canada remain under-resourced, with long waits and inequitable access. These circumstances can produce or exacerbate the suffering that may drive MAID requests and suicidal thoughts and behaviours.
My recommendation is straightforward. Do not expand MAID to cases where the sole underlying condition is a mental disorder. This recommendation aligns with the position of the International Association for Suicide Prevention that the overlap between MAID requests and suicide makes distinguishing between them impossible. MAID for mental illness will undermine suicide prevention by positioning MAID as a viable alternative to treatment.
Suicide is preventable. The vast majority of people who contemplate or attempt suicide do not go on to die by suicide. Public health approaches to suicide prevention have been a priority in Canada, which is one of the reasons that the establishment of 988 received unanimous support in the House of Commons. Given the significant overlap between suicidal thoughts and behaviours in MAID, we will best serve those who are suffering by enhancing suicide prevention efforts and by shifting our focus to medical assistance in living. That is what Canadians deserve.
Thank you.