Let's talk about suicide

Globe and Mail Update

We campaign for a solution to prevent the deaths of Canadians waiting for organ transplants. We wear ribbons and advocate for safe sex to protect our loved ones from HIV/AIDS infection. We break down barriers and speak openly about colonoscopies and prostate exams as means for early detection of cancers.

Yet, when it comes to the more than 4,000 Canadians who die from suicide each year, we are curiously silent.

Scan the obituaries and you'll find these Canadians. Most are young and male. And their cause of death remains unmentioned, thinly veiled behind the word ”suddenly.” But this killer does have a name, and its onset is rarely sudden. It's called mental illness: Most people who kill themselves are suffering from a diagnosable mental illness, with depression as the most common of these.

Depression is now the fourth leading cause of disability and premature death in the world, according to the Public Health Agency of Canada. And the World Health Organization predicts that, by 2020, depression will move up the ranks and become the second leading cause of disability in the world, preceded only by heart disease.

The WHO tells us that, worldwide, someone commits suicide every 40 seconds. In Canada, suicide is one of the leading causes of death for both men and women from adolescence to middle age. Since Jan. 1, 2000, we have lost nearly 31,000 Canadians to suicide. And that number is the reported number; countless suicides continue to go unreported.

So, in the midst of a clear health crisis, why are we still so reluctant to speak about mental illness? The dark truth is, we still believe many of the myths around suicide, and mental illness in general.

The most pervasive and insidious of these are that suicide is volitional, that it is morally wrong, and that the suicidal are weak and selfish. With these kinds of attitudes, it's not surprising that suicidal people isolate themselves or that families whose loved ones died by suicide choose to stay silent on the cause of death.

We need to take a hard look at these ingrained and discriminatory attitudes toward the mentally ill. At the most harmful levels, these misconceptions rob people of rightful life opportunities. At other levels, they result in a failure to prioritize mental health issues in the political arena.

Suicide is not chosen; it happens when pain exceeds the resources for coping with pain. It follows, then, that to help prevent suicide, we need to lessen the mental and physical pain caused by the illness itself. But we also need to lessen the emotional pain that comes from facing public stigma. Only in doing so can we encourage sufferers to freely seek out treatment. And, finally, we need to ensure that our communities actually have the health resources –knowledgeable mental health professionals, emergency rooms capable of swiftly handling patients in a mental health crisis and community supports readily available to those who need them.

This kind of approach has brought tangible progress in other countries. Now Canada will have its turn, with the federal government's recent establishment of the Canadian Mental Health Commission, chaired by Michael Kirby.

One of the commission's objectives will be to develop strategies to help increase Canadians' understanding of mental health and mental illness and thus reduce stigma. New Zealand's highly successful anti-stigma campaign, called Like Minds Like Mine, has shown demonstrable shifts in both attitudes and behaviours. Its success can be attributed to: Dedicated senior government leadership willing to champion the project; Adequate and sustained funding over the long haul; Taking the long view, with continued activity over time.

Well-defined goals (awareness is not enough; attitudinal and behaviour changes must result); Clear understanding of the intended audience; Approaching the problem from multiple directions: education, policy and procedural changes, new practices and improved standards; Evaluating right from the outset, and using the results to correct messages and change activities on a continuing basis, as well as to measure outcomes.

The government, through the commission, will be doing its part to battle stigma and promote mental health. As individuals, let's do ours.

Deaths from suicide are preventable. Depression is a highly treatable disorder. Eighty per cent of those who seek treatment for depression respond well.

Yet, 90 per cent of those who have depression never actually seek treatment. Why is that? A large part of the answer lies in cultural and societal stigma, which often expresses itself through silence. This week is Mental Illness Awareness Week in Canada. Let's talk about mental illness. Let's talk about suicide.

Phil Upshall is national executive director of the Mood Disorders Society of Canada and director of Mental Illness Awareness Week.

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