Ain’t Got Time For Bullshit – 2. Suicide

By Dr. David Laing Dawson

Another article about assessing for suicide risk arrived in my psychiatric/medical feed today.

With small variations in the age and numbers and demographics over the past 30 years the suicide rate in Canada has remained relatively stable at 11.8 per 100,000 population per year. That’s about 12 per day in all of Canada. This is happening despite twenty or thirty years now of public awareness campaigns, crisis line phone numbers, and more and more attention being paid (and being insisted upon by professional bodies) to detecting suicide ideation and suicide risk, by nurses, doctors, teachers, counsellors.

Any TV show that reports or depicts a suicide, in the news or in a fiction, starts with a warning, and ends with a crisis line phone number to call.

None of these actions and activities, campaigns and warnings, has changed the number of people who kill themselves. Individuals may have been helped but the overall rate remains unchanged.

A different approach is called for if we want to do more than virtue signalling.

Perhaps we need to look at the causes, the known at-risk populations, and do something about those situations in which we have the tools and treatments to make a difference. That is, focus on the populations for which it is possible to intervene effectively.

And the first of those should be the treatable illnesses with very high risk when untreated, undetected, or under treated. And ensure these illnesses are detected and treated with good continuity of care.

These would be:

Schizophrenia

Depression

PTSD

Anxiety Disorder

For schizophrenia this means adequate detection and treatment at onset, continuing care and support, not being prematurely discharged from hospital, having support and legal mechanisms to ensure compliance on medication, family involved in care.

Then depression.

Suicide rate increases with age, and is especially high in older single males. A number of factors are involved with this demographic, and we can work to improve all of them, but the cause that is most easily detected and treated is depression.

A demographic with very high suicide incidence is “recently discharged psychiatric patients”. So here we need to reduce the number of premature hospital discharges, and ensure continuity of care.

And then we have suicide by teens and youth. Some of these fall under the categories above, but teenage suicides can also be the result of impulsivity, peer influence and shame, an adolescent’s limited appreciation or awareness of consequences, limited capacity for a long perspective, social media influence or shaming, and immediate availability of means.

And any program of education and awareness must consider the result of anti-smoking campaigns in Secondary Schools a generation ago. When teens were shown the consequences of cigarette smoking by lecture or film, the number of teens smoking increased.

For teens then, we need to be aware of and treat schizophrenia, depression, anxiety, trauma, and not rely on suicide awareness campaigns. They should have no access to guns and potentially lethal pills, and limited or monitored use of social media. Parents and teachers should be alert to changes in social behaviour such as abrupt avoidance and isolation. Doctors, counsellors, and therapists seeing teenagers should involve the parents or parent in some way. And remember when a teen says, “I don’t want my parent(s) to know”, he or she really means, “I’m embarrassed but I would really like their help.”