Talking about suicide without proper supports can be dangerous, experts say
'Could we, with all the best intentions, be doing more harm than good?'
As people scramble to cope with a spate of suicides and suicide attempts in Woodstock, Ont., experts warn that simply opening up discussion is not an effective way to prevent other suicides — and can even be dangerous — without the right supports in place.
"When something like this happens, everyone wants to do something right away and they kind of come out of the woodwork," said Ian Manion, a psychologist specializing in youth suicide told CBC News. "You have a lot of well-intentioned people and sometimes [good] intentions don't always lead to good actions.
"Sometimes it could be enhancing risk." he said.
Five young people have died by suicide in four months in Woodstock, a southwestern Ontario city with a population of about 35,000. It's not the only community in Canada dealing with multiple suicides or suicide attempts. In April, Attawapiskat First Nation declared a state of emergency when 11 people tried to take their own lives in one night.
Experts say suicide is an urgent national problem, as the second-leading cause of death, after accidents, among Canadians aged 15 to 24.
Manion, who is the director of Youth Mental Health Research at the Royal Ottawa Mental Health Centre, has been in contact with the Woodstock, Ont., school board. On Tuesday, hundreds of high school students walked out of class to rally against teen suicide and raise awareness about the need for mental health services.
The danger facing communities in the aftermath of suicide, experts say, is "contagion," when people already at high risk start thinking of suicide after others have killed themselves.
Dr. Stan Kutcher, a professor of psychiatry at Dalhousie University who, like Manion, specializes in youth mental health and suicide, said he worries that "let's talk about suicide in the community" responses haven't been scientifically tested enough to prove they actually prevent other suicides.
"What we have done in Canada is we have very enthusiastically taken up a community-based approach, without knowing whether or not it works and without knowing whether or not it's safe," Kutcher said. "Could we, with all the best intentions, be doing more harm than good? And I don't know the answer to that question but we have to ask."
But Manion said there is no question that people need to talk about suicide in the community. The issue, he said, is how people talk about it.
"Just having a conversation is insufficient," Manion said. "If you go to a high school and you have a suicide expert stand up in front of 1500 students and talk about suicidal warning signs and then leaves and that's all you do, there is evidence to suggest that that is dangerous."
Without support services in place, a gathering like that can trigger suicidal thoughts in vulnerable people, he said, who then have "nowhere to deal with them, nothing to do about them."
In conjunction with public awareness conversations about suicide, it's critical to make sure that people know where they can turn for help, how to access those services and how to "bridge" a friend to an appropriate service, Manion said.
Kutcher advocates for a more targeted approach, specifically aimed at people proven to be at higher risk for suicide. The most important risk factors, he said, are previous suicide attempts; mental illness, including depression, schizophrenia and bipolar disorder; and alcoholism.
"You don't have to be a rocket scientist to figure out that if you're going to intervene effectively you need to intervene where the problem is at its greatest," he said.
Both Manion and Kutcher agree that suicide prevention studies in Europe have shown some promising results that could help Canadians.
The European interventions, which reduced suicide rates, linked people at higher risk with treatment.
But Manion said they also showed the importance of a "whole community approach," by training community facilitators to identify those at risk and by building public awareness about mental illness and suicide.
'What should we be doing?'
Another vital step communities need to take in suicide prevention, Manion said, is "meaningful engagement" of young people, including listening to their thoughts on what supports they need and what needs to change.
That kind of knowledge about some of the "right" ways to deal with suicide already exists, he said, but the fact that communities across Canada don't have that information in hand before crisis strikes is a major problem.
A solution to that problem, he said, is a national suicide prevention strategy and action plan for communities.
"You have community after community that are facing such really tragic circumstances and the communities are saying, 'what should we be doing?'" he said.
"Rather than a community kind of trying to figure that all that out in the middle of a crisis, can you imagine if it was proactive and all the material was available to every community so they could actually do it in advance and not be reactive?"
Where to get help
If you, or someone you know is at risk of suicide, here's how to get help:
In French: Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553)
Canadian Association for Suicide Prevention: Find a 24-hour crisis centre
U.S.-based National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
- Suicidal thoughts.
- Substance abuse.
- Feeling trapped.
- Hopelessness and helplessness.
- Mood changes.