SUICIDE PREVENTION

Suicide Prevention and Bill C-300:

Toward A Federal Framework in Canada
Jerilyn J. Dressler
University of Calgary
SOWK 632
March 22, 2013

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Suicide, the act of taking ones own life, directly or indirectly impacts millions of people
world-wide each year. Suicide not only ends a life, but forever changes the lives of those who are
left to cope with the loss. The act of taking ones own life is difficult for many people to
comprehend at first glance, it certainly appears to be counter-intuitive in regard to the natural
drive to live, thrive, and perpetuate as a species. Those who are suicidal almost always wish to
escape unbearable emotional pain. Other factors contributing to suicidal thoughts and
behaviours, however, are complex and vary from person to person. The lack of understanding
about the complex issue of suicide contributes to the struggle of many suicide attempt survivors
and suicide survivors, those who mourn someone lost to suicide, in finding healing.
Unlike many other health issues impacting people across the world, suicide is
preventable. Examining the factors contributing to suicide gives us an idea of where to start in
addressing suicide prevention, but is not a solution in and of itself. Suicide and mental health, for
example, are closely linked, but separate and distinct issues. Research out of the United States
shows that more than 90% of those who died by suicide had an official mental health diagnosis;
60% of them being mood disorders including depression (American Medical Association, 2005).
Other factors contributing to suicidal thoughts and behaviours include addiction, feelings of
isolation, feelings of being a burden, and feelings of hopelessness and helplessness.
Environmental factors like access to lethal means of committing suicide and cultural norms and
values also play a role. Addressing the factors contributing to suicide is only one piece of suicide
prevention strategy and policy.
The consequences of suicide for individuals, families, and communities are substantial,
and potentially devastating. According to the World Health Organization (2000), each suicide
has a serious impact on at least six people. Those who lose someone to suicide have an increased

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risk of suicidal thoughts and behaviours themselves. In addition to the consequences for
individuals, families, and communities, the public health costs and loss of economic productivity
are significant. It is important for all communities and societies to make an effort to understand
suicide and help prevent its incidence. In the following pages, I will discuss why the issue of
suicide is particularly important to the field of social work and address efforts that have been
made to prevent suicide at the policy level within a variety of scopes and locations: within a
community agency in Calgary, Alberta, within the city of Calgary, Alberta, within the Province
of Alberta, and within Canada. In addition, I will discuss international and global efforts that
have impacted national suicide prevention strategies the world over, in spite of which Canada
has yet to commit to a national suicide prevention strategy.

Canadian Association of Social Workers (CASW) Code of Ethics

Because a great deal of the work I do and believe in involves the most micro level of
suicide prevention, suicide intervention, I personally consider suicide an issue deserving of the
attention of policy-makers at all levels of relevant administration. If we look to the CASW Code
of Ethics, I would argue that it makes a very strong case for suicide to be a priority in the field of
social work. The profession of social work in Alberta is regulated by the Alberta College of
Social Workers and adheres to the CASWs Code of Ethics. The Code outlines six core values to
guide social work practice in Canada, including: respect for the inherent dignity and worth of
persons, pursuit of social justice, service to humanity, integrity of professional practice,
confidentiality in professional practice, and competence in professional practice (CASW, 2005).
While the last three values are relevant at the micro-level, to the individual social workers
practice, the first three values are over-arching and applicable to the broader issues with which

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the field of social work concerns itself. These first three values of the CASWs Code of Ethics
are all particularly relevant when considering the importance of the issue of suicide.
Protecting life and quality of life is of great importance to the field. Everything that can
be done to prevent the foreseeable loss of life should be done; for example, intervening without
the clients consent. That being said, making the decision to initiate emergency intervention on
behalf of a suicidal client is a very difficult decision. It is, in fact, an ethical dilemma also
captured within this first value, which outlines the great importance social workers place on
client self-determination. It is a decision that is not made lightly, and is usually made only after
consulting a risk assessment tool and/or a supervisor or manager. All possible alternatives must
be explored before making the decision to intervene without a clients consent. Social workers
also have an important role to play in ensuring that life and quality of life is protected in a
preventative way; that populations with a higher risk of suicide are able to receive the support
and treatment they need before experiencing suicidal thoughts and behaviours. This means that
the field of social work must engage in: 1) research to identify, treat and support vulnerable
populations, 2) public education, 3) lobbying administrative bodies and governments to influence
policy, and 4) work with administrative bodies to create and enact policies that will ensure that
life and quality of life is protected.
The pursuit of social justice is another value guiding the field of social works
involvement in suicide prevention. Those who are contemplating suicide are vulnerable, often
experiencing many barriers to accessing service, including the stigma of suicide or pre-existing
conditions like mental illness or homelessness. It is important that the field of social work try to
minimize and/or eliminate such barriers and ensure that all Canadians have access to the help
and support they need. I believe that Executive Director of the Canadian Association of Suicide

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Prevention Tim Walls Report to the Parliamentary Committee on Palliative and Compassionate
Care - Suicide A National Tragedy, A National Disgrace - is an excellent example of social
justice work in the field of social work. Bringing attention and awareness to the issue and stigma
of suicide, using inflammatory language if necessary, is the only way to address the stigma of
suicide and was an excellent strategy to motivate Canadas federal government to take action. I
discuss Tim Walls report in greater detail in the pages below.
Finally, social works value of service to humanity motivates social workers and social
work agencies to prevent suicide and the potentially devastating impact it can have on
individuals, families, and communities. As social workers we can serve humanity at all levels of
suicide prevention, including suicide intervention, as managers of programs and agencies
providing crisis support or suicide education, sitting on boards coordinating suicide prevention
efforts, and lobbying and assisting policy-makers regarding suicide prevention strategies. The
significant impact workers and agencies have had on suicide prevention policy at the community,
provincial, national and international level is made clear throughout the discussion in the
following pages.

Suicide Intervention Distress Centre Calgary

At the most basic or micro level of suicide prevention is suicide intervention. Caplan
(1964, as cited in Anderson & Jenkins, 2005) would consider suicide intervention a tertiary level
of prevention in the context of public health. Primary prevention targets populations, not
individuals (e.g. awareness programs), and secondary prevention includes early treatment of
individuals at risk (e.g. mental health treatment). Suicide intervention occurs at an individual
level, when a professional or person in the community acts to prevent the imminent risk of

SUICIDE PREVENTION

someone taking their own life. Ideally, primary prevention and secondary prevention efforts
prevent individuals from requiring tertiary prevention. All levels of prevention are part of a
comprehensive suicide prevention strategy.
Distress Centre Calgary is a social work organization delivering crisis support and
information and referral 24/7, via one-on-one counselling, phone lines, e-mails, online chat, and
text. I am employed at the Centre as the Contact Centre Manager, where I oversee 200-plus
volunteers and approximately 50 staff who ensure that contacts for crisis and support are
answered at any time of day or night. Suicide was discussed on 6% of Distress Centres crisis
contacts in 2012, with a portion of those contacts requiring emergency intervention via Calgary
Police or Emergency Medical Services. The goal of crisis and suicide intervention at the Distress
Centre is to mitigate any risk using the least intrusive measures possible, but alas, this is not
always possible. Sending police to respond to individuals who are suicidal or in crisis is not
ideal, and can exacerbate the situation as police are often ill-equipped to deal with those who are
suicidal or have mental health concerns. Research published last week out of the University of
Edmonton has shown that training police officers to use appropriate body language and empathy
on mental health calls can reduce the need for use of force, as well as improve outcomes for the
individual in crisis (Krameddine, DeMarco, Hassel & Silverstone, 2013). It is the first police
training program of its kind in Canada.
Distress Centre has implemented a number of policies and procedures to guide its
volunteer and staff responses to the risk of suicide. The Centre has grown significantly from its
origins as the Drug Information Centre, a grassroots, street-level organization established in
1970. After its inception, The Drug Information/Distress Centres crisis support quickly became
integral to the Calgary community. In 1999, the Crisis Pilot Project joined Distress Centre,

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Alberta Health Services Mobile Response Team and Woods Homes Community Resource
Team in partnership, with Distress Centre serving as the hub for the agencies phone support. It
was at this time of significant opportunity and growth that policies and procedures were designed
and implemented to professionalize volunteers crisis response and standardize their response to
risk situations on the crisis lines. Immediate professional staff support was provided for
volunteers, and procedural directories, or decision trees were created for each risk situation
(including suicide, domestic violence, and child welfare, among others). The decision trees have
been re-examined and reworked over the years in order to remain reflective of current research
and best practices. The Suicide Decision Tree is most commonly utilized, and gently guides
volunteers and staffs suicide risk assessments without being overly authoritative (please see
Appendix). Experts in the field of suicidology, readily accessible in the city of Calgary, were
consulted at the time of their creation and again upon their re-examination.

The Centre for Suicide Prevention Calgary

In conversation with Distress Centres Vice-President of Operations Joan Roy on March
13, 2013, I was able to learn a great deal about the history of organized suicide prevention efforts
in the city of Calgary. In her 20-plus years at the Distress Centre, Ms. Roy has occupied many
roles. She has been Distress Centres resident suicidologist since 1998. In addition to being VP
of Operations at Distress Centre, she is an Applied Suicide Intervention Skills (ASIST) trainer
through the Centre for Suicide Prevention. In my opinion, her experience and knowledge are
invaluable to the Distress Centre and to the social work profession as a whole, particularly in
regard to local suicide prevention efforts.

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The Centre for Suicide Prevention (CSP) is a Calgary-based organization focusing on

educating Albertans about suicide prevention. They believe that, prevention is the only solution
to suicide (CSP, 2013). The organization is affiliated with the Canadian Mental Health
Association and LivingWorks, and is responsible for organizing Applied Suicide Intervention
Skills Training (ASIST) throughout the province of Alberta. Being aware that CSP is responsible
for organizing ASIST training in Alberta, I was confused upon learning that LivingWorks is
responsible for organizing ASIST training in the rest of North America. Joan Roy explained the
reason for this, which was quite interesting to me as a Calgarian LivingWorks and ASIST
training has its origins in Calgary, with direct ties to the University of Calgarys Faculty of
Social Work. Richard Ramsay, formerly a professor at the Faculty of Social Work, was part of a
multi-disciplinary team that created the ASIST program and established LivingWorks in the
early 1980s. Out of respect for the CSP, which had been founded in 1981 and was doing
excellent work in the Calgary community, the team joined forces with the organization to deliver
the ASIST program. Both organizations are dedicated to education about suicide intervention to
reduce the incidence of suicide. CSP boasts the largest English language collection of suiciderelated materials with over 45 000 items an incredible resource to have at our fingertips right
here in Calgary. Ramsay had a significant impact not only on local suicide prevention efforts, but
on global efforts as well through work with the United Nations (see The United Nations and
World Health Organization, p. 12).

The Province of Alberta

In 2009, 486 deaths were investigated as suicide by the Alberta Office of the Chief
Medical Examiner (Office of the Chief Medical Examiner, 2009 the most recent annual report).

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This is a conservative estimate of the number of deaths by suicide that occurred in the province,
as many suicides are unreported or unconfirmed for several reasons, e.g. they appear accidental
in nature or are not reported or investigated due to religious beliefs. Furthermore, for each death
by suicide there are five hospitalizations and 14 emergency room visits in the Province (Alberta
Centre for Injury Control and Research, 2012). Numbers and statistics, of course, cannot
possibly capture the full impact of suicide and suicide attempts on individuals, families, and
communities. At Distress Centre, we often support suicidal callers in need of emergency medical
transport and assistance, or, preferably, prevent the caller from requiring emergency medical
assistance through crisis and suicide intervention. Distress Centre staff and volunteers also
support family and community members struggling with how to respond to a suicidal loved one,
or coping with the loss of a loved one to suicide. It is at the individual, one-on-one level where
stories of the heart are told and heard, and we see the true impact suicide has on people. We hear
from people who have lost a child, a parent, a sibling, a close friend, and are struggling to
understand their loss and dealing with feelings of guilt and shame. They are, in fact, at higher
risk of suicide themselves having lost a loved one to suicide.
Suicide is a leading cause of death in Alberta, and the suicide rate in Alberta is
significantly higher than the national average (Alberta Mental Health Board, 2005b & Canadian
Association of Suicide Prevention, 2013). I hypothesize that Albertas oil and gas-based, boom
and bust economy plays a role in our Provinces higher than average rate of suicide. The factors
that contribute to an increased risk of suicidal thoughts and behaviours are likely exacerbated by
a boom and bust economy; for example, increased feelings of isolation due to people flocking to
Alberta, away from their families and friends, for work; increased alcohol and drug abuse,
related to both feelings of isolation and a booming economy; decrease in impulse control due to

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increased drug and alcohol abuse; and feelings of hopelessness or helplessness during downward
turns in the economy. Those of lower socio-economic status, of course, are more vulnerable to
the ebb and flow of Albertas economy. It was clear that Alberta needed to protect its residents
from the risk of suicide, particularly its most vulnerable and at-risk residents.
In 2005, the Province (likely motivated by global trends in suicide prevention strategies
and the significant contributions of Albertans to these trends) recognized that the efforts of
community and health agencies were not enough to address the complex issue of suicide; that
something needed to be done at a higher level. It was at this time that the Alberta Mental Health
Board created Albertas Suicide Prevention Strategy. Like all good policies, a working group
was created with broad representation from those who those with first-hand knowledge of
suicide, including survivors, community and health agencies working with those who are suicidal
or at higher risk for suicide, researchers specializing in suicide, and government representatives.
I believe that the importance of this type of representation is to ensure that the heart-stories are
told and heard; motivating policy-makers and helping them understand the true impact of suicide
beyond the numbers and statistics that often guide their decisions.
The goal of Albertas Suicide Prevention Strategy was to reduce the incidence of suicide
by 19%. It included a focus on priority groups including those with a higher risk for suicide:
Aboriginal peoples; those who have lost someone to suicide; those who are chronically or
terminally ill; those who have been diagnosed with a mental illness; the elderly; the homeless;
those in custody at a correctional facility; those living in remote or rural areas; those struggling
with substance abuse or problem gambling; middle-aged men; individuals who have previously
attempted suicide; school-aged teens and young adults; those who identify as lesbian, gay, bisexual, or trans-sexual; students, general labourers, and homemakers; and victims of family

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violence. When looking at these populations as a group, I believe they may have a number of
things in common, potentially contributing to their increased risk of suicidal thoughts and
behaviours. Feelings of hopelessness or helplessness, feelings of isolation, and a struggle with
impulse control are commonalities among some, but not all, of these groups. Middle-aged men
and general labourers, more likely to be men, may simply be more likely to choose a more lethal
means of attempting suicide, such as hanging or using a firearm. The data certainly shows us that
men are more likely to choose more lethal means than women (e.g. Alberta Centre for Injury
Control and Research, 2012).
How did the Province plan to reduce suicide by 19%? The following is taken directly
from A Call to Action: The Alberta Suicide Prevention Strategy (Alberta Mental Health Board,
2005a):
1. Secure targeted and sustainable funding to implement the Alberta Suicide Prevention
Strategy.
2. Enhance mental health and well-being among Albertans.
3. Improve intervention and treatment for those at risk of suicide in Alberta.
4. Improve intervention and support for Albertans affected by suicide.
5. Increase efforts to reduce access to lethal means of suicide.
6. Increase research activities in Alberta on suicide, suicidal behaviour, and suicide
prevention.
7. Improve suicide and suicidal behaviour-related surveillance systems in Alberta.
8. Increase evaluation and continuous quality improvement activities in Alberta for
suicide prevention programs. (p. 22).

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Although I was unable to find a formal evaluation of the strategy, the Office of the Chief
Medical Examiner Annual Reports show that the incidence of suicide remained unchanged
between 2005 and 2009 approximately 13 in 100,000. Fortunately, the individual goals of the
strategy are valuable nonetheless, despite not having an impact upon suicide rates in the
Province. One can assume that, if nothing else, the strategy brought much-needed attention to the
issue of suicide and mental health in Alberta. Awareness and education is a significant goal of
suicide prevention strategies. It is by promoting suicide prevention strategies that the United
Nations and the World Health Organization are bringing awareness of the issue of suicide to the
international community.

The United Nations and World Health Organization

Suicide has become a leading cause of death worldwide, with someone around the world
dying by suicide every 40 seconds (World Health Organization, 2012). The World Health
Organization (WHO) and the United Nations (UN) have supported countries in establishing
nation-wide suicide prevention strategies, and there is evidence that such strategies are indeed
effective. The path to the UNs promotion of national suicide prevention strategies is an
interesting one. In the late 1980s, the UN had an increased focus on national social policies
aimed at improving the lives of vulnerable citizens across the world. In the early 1990s, the UN
requested input from governments, NGOs, and universities around the world to identify progress
regarding issues being addressed by social policies. It was input from a multi-disciplinary team
in Calgary including Richard Ramsay of the University of Calgarys Faculty of Social Work that
inspired the UN to address the issue of national suicide prevention (Ramsay & FSW, 2001). In
1996, following a meeting of 15 culturally and regionally diverse UN members in Banff, the UN

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published Prevention of Suicide: Guidelines for the Formulation and Implementation of

National Strategies. The document encouraged a multi-disciplinary approach with co-operation
between sectors, and identified key elements contributing to the success of the strategies,
including: support from government policy, using a conceptual framework outlining possible
courses of action, well-defined aims and goals, measurable objectives, identification of agencies
and organizations capable of implementing those objectives, and ongoing monitoring and
evaluation. In addition, the document recommended activities to achieve the goals outlined in the
strategies, including: early identification, assessment, treatment, and referral of at-risk
individuals; increased public and professional access to information regarding suicide
prevention; identification of at-risk groups; promotion of public awareness of mental health,
suicide, and crisis; maintenance of a training program for gatekeepers (e.g. police, mental
health professionals); responsible reporting by the media; promotion of supports for those at risk
or affected by suicide; reduction in the availability and accessibility of lethal means; and
establishment of organizations for research, training, and service delivery.
Locally relevant, recent research and current events provide further support to the UNs
guidelines. Research by Statistics Canada (2011) shows just how imperative the gatekeepers
strategy is: Albertans who died by suicide averaged twice the number of health service visits
than those who did not die by suicide, including emergency room visits, hospital stays, and
accessing community mental health supports. The WHO (2000) has published a suicide
prevention resource for primary health care workers to address the gatekeeper issue.
Cultural differences in regard to firearms in Canada and the United States have been
under the microscope recently, particularly in the media and in response to the Sandy Hook
Elementary Shootings in December of 2012. The percentage of suicides completed using a

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firearm in the United States is approximately double the percentage of suicides completed using
a firearm in Canada (~50% vs ~25%; Centers for Disease Control and Prevention, 2013, and
Department of Justice Canada, 2012). Gun control and gun culture in the countries differ
significantly, with our neighbours to the south valuing and clinging to their constitutional right to
bear arms while Canada opts for relatively strict gun laws and gun control. Gun control clearly
prevents those who are suicidal and homicidal from using firearms to harm themselves or others.
In 2008, the WHO identified suicide as a priority condition in their Mental Health Gap
Action Programme. Subsequently, the WHO published an updated resource to assist
governments in establishing a national suicide prevention strategy in 2012: Public Health
Action for the Prevention of Suicide: A Framework. Recommended steps in this document
include: identifying stakeholders, undertaking a situation analysis, assessing the requirement and
availability of resources, achieving political commitment, addressing stigma, and increasing
awareness. In addition, the Framework includes recommended key components of national
suicide prevention strategies: clear objectives, relevant risk and protective factors, effective
interventions, prevention strategies at the general population level, prevention strategies for the
vulnerable sub-populations at risk, prevention strategies at the individual level, improving case
registration and conducting research, and monitoring and evaluation.
With leadership from the UN and the WHO, suicide has received the international
attention it deserves as an issue that should be addressed at the national government policy level.
Finland was the first country to develop and implement a national suicide prevention strategy in
the mid-1980s, and has seen a significant decrease in lives lost to suicide in the years since
(Anderson & Jenkins, 2005). Thanks to the UN and WHO, governments and non-governmental
organizations have tangible resources and research at their fingertips to assist them in

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establishing their own suicide prevention strategies. Canada is moving towards addressing
suicide prevention at a national level, although it may fall short of creating a national suicide
prevention strategy.

Toward a National Suicide Prevention Strategy in Canada?

On average, over 3,500 Canadians are lost each year to suicide (CASP, 2006). The
Canadian Association of Suicide Prevention (CASP) has been lobbying for a national suicide
prevention strategy for nearly two decades. They believe a national strategy will unite the suicide
prevention, intervention, and postvention efforts happening across the country at varying levels,
and consider Canadas delay in accepting responsibility at the federal level a disgrace (CASP,
2013). The federal government itself recognizes that there are significant flaws in the way mental
health and addiction services are established and functioning in this country the May 2006
Final Report of The Standing Senate Committee on Social Affairs, Science and Technology,
Out of the Shadows at Last, described mental health and addiction services as fragmented,
chronically underfunded, and in the shadow of stigma and government inattention (p. 205). In
a 2011 report to the Parliamentary Committee on Palliative and Compassionate Care, Tim Wall,
Executive Director of CASP, accuses the federal government of passing the responsibility of
suicide prevention off to the provinces and territories and of ignoring the WHOs declarations
that suicide is a public health issue requiring attention at the national level. He also outlines the
significant work done by CASP without the support of public funds, with a board made entirely
of volunteers, and with many in-kind donations from already underfunded agencies specializing
in crisis and suicide intervention. While Wall recognizes that the Mental Health Commission of
Canadas 2009 mental health strategy was a step in the right direction, it did not directly address

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the issue of suicide, and is indeed only one piece of a successful national suicide prevention
strategy (as outlined above).
Part of CASPs lobbying for a national suicide prevention strategy included circulating a
petition Canada-wide. In fact, I signed this petition when it circulated at the Distress Centre in
2011. The petition was in support of private members bills tabled earlier that year. Bills C-593
and C-297 proposed a national suicide prevention strategy and were tabled by Megan Leslie of
the NDP party in 2011. They were not passed. Private members bills often dont become law, as
they are: 1) submitted by private members of parliament rather than cabinet ministers; 2)
randomly selected for debate in parliament, and 3) given much less time for debate and
consideration when randomly selected than government bills submitted by cabinet ministers
(Parliament of Canada, 2013; T. Wall, personal communication, Mar. 21, 2013). Bill C-300, An
Act Respecting a Federal Framework for Suicide Prevention, was tabled by Harold Albrecht of
the Progressive Conservative Party on October 4, 2011. It was a private members bill randomly
selected for debate in parliament. It passed all three readings in parliament and all three readings
in the Senate. On December 14, 2012, the bill received Royal Assent and has now become law.
What does this mean? According to Harold Albrechts website, it means that within 180
days of the bill receiving Royal Assent, the government of Canada is required to assign an
authority responsible for establishing a working committee, including other levels of government
and interested non-governmental organizations and stakeholders. Within four years, and every
two years after that, the committee is expected to report back to parliament on the progress it has
made and the actions it has taken. Taken directly from Harold Albrechts (2013) website:
The framework will require the Government of Canada to:

provide guidelines to improve public awareness and knowledge about suicide;

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disseminate information about suicide, including information concerning its prevention;

make statistics publicly available regarding suicide and its related risk factors;

promote collaboration and knowledge exchange in suicide prevention;

define the best practices for the prevention of suicide; and

promote the use of research and evidence-based practices for the prevention of suicide.

CASP has done an incredible amount of work in paving the way for a national suicide
prevention strategy. They have created a blueprint for a national suicide prevention strategy, a
collaborative effort between many organizations and professionals across Canada. The first
edition was released in October of 2004, and the second in 2009. The federal government failed
to take notice despite being submitted to several governments over a number of years. The
Strategy did, however, influence the work done in Alberta and Nova Scotia when implementing
their provincial suicide prevention strategies in the years following (2005 and 2006,
respectively). The goals and objectives of the strategy fall under four broad categories:
awareness and understanding, prevention and intervention and postvention, knowledge
development and transfer, and funding and support. The principles guiding the 2009 Strategy are
very powerful, and speak to me on many levels:
1. Suicide prevention is everyones responsibility.
2. Canadians respect our multicultural and diverse society and accept responsibility to
support the dignity of human life.
3. Suicide is an interaction of biological, psychological, social and spiritual factors and can
be influenced by societal attitudes and conditions.
4. Strategies must be humane, kindly, effective, caring and should be:
a) Evidence or experience based.

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b) Active and informed.

c) Respectful of community and culture-based knowledge.
d) Inclusive of research, surveillance, evaluation, accountability and reporting.
e) Reflective of evolving knowledge and practices.
5. Many suicides are preventable by knowledgeable, caring, compassionate and committed
communities.
6. We must have the courage to confront the stigma of suicide and the patience to address
mental health literacy on both a national and local level. (p. 10)
These principles not only speak to me, but are very much aligned with the values of social
work as outlined in the CASW Code of Ethics. After researching both Bill C-300 and The CASP
National Suicide Prevention Strategy, I believed that Canada was well on its way to
implementing a successful national suicide prevention strategy. After speaking with Tim Wall
directly, however, my feelings of hope were somewhat deflated.
On the morning of March 21, 2013, I had the pleasure of speaking with Tim Wall from his
office in Winnipeg about the status of Canadas national suicide prevention strategy. CASP is
highly respected at the national level, and has been invited to report to the Parliamentary
Committee on Palliative and Compassionate Care, the Standing Committee on Health, and the
Standing Committee of Veterans Affairs on three separate occasions. Despite a high level of
engagement with the federal government, CASP has lobbied the federal government regarding a
national suicide prevention strategy for many years with little success. The most significant
barrier is that the federal government believes suicide prevention to be the provinces and
territories responsibility. The federal government funds health services, which the provinces and
territories then administer. Wall described a conversation he had with an MP while on a flight

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from Winnipeg to Ottawa: upon debating who is responsible for suicide prevention in Canada,
the MP posed the question, Why would you bring an electrician in to do a plumbers job?,
implying that the federal government has no place in the development of a suicide prevention
strategy for the provinces and territories. Wall responded that a general contractor is required to
do an adequate job on any construction site, comparing the role that a federal government is
expected to play in a national suicide prevention strategy to the one that a contractor plays on a
construction site. Their primary responsibility is to facilitate and coordinate the efforts happening
on the ground. Remember, the federal government itself (the Standing Senate Committee on
Social Affairs, Science and Technology Out of the Shadows at Last) described mental health
and addiction services as fragmented, chronically underfunded, and in the shadow of stigma
and government inattention (p. 205).
The problem with Bill C-300, according to Wall, is that it has arisen from a private
members bill. This means that there is no funding attached to the Bill as it was not born out of
federal government initiative or responsibility. Secondly, Bill C-300 calls for a federal
framework for suicide prevention. Wall believes that this language is a way for the federal
government to avoid responsibility for establishing a national suicide prevention strategy. Bills
C-297 and C-593, as previously mentioned, called for a national suicide prevention strategy.
Perhaps Albrecht was aware that a bill calling for a national suicide prevention strategy was
unlikely to pass in parliament, and changed the language to reflect the federal governments view
that the provinces and territories are responsible for the implementation of suicide prevention
strategies. Bill C-300 requires that the federal government take action, but does not require that
they attach funding to the action or accept responsibility for implementing a strategy. The action
words associated with Bill C-300 are provide guidelines, disseminate information, make

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statistics publicly available, promote collaboration, define best practices, and promote the use of
research and evidence-based practices (emphasis is mine). Wall fears we may see a limited
response from the federal government, and that the framework may not address the UN and
WHO recommendations. Regardless of the outcome, CASP will be involved in establishing the
framework along with other key stakeholders. CASP had, in fact, already established a National
Suicide Prevention Collaborative including the Mental Health Commission of Canada and the
Public Health Agency of Canada in anticipation of the Bill being passed.
When asked why he thinks Canada has taken such a long time to address the issue of
suicide at the national level, Wall identified several factors in addition to the provincial/federal
jurisdiction issue. The issue of suicide continues to carry a significant amount of stigma. Wall
stated that suicide is not only an uncomfortable topic, but also a complex issue. There is no
one clear answer or response to suicide, which makes addressing the issue overwhelming and
messy. Wall identified that there are high levels of fear and denial in regard to the impact
suicide has in our country, and resistance to change when it comes to federal policy regarding
health administration. There are, of course, significant economic concerns as well. Wall and I
discussed the irony of the federal governments reluctance to comply with the UN and WHOs
recommendations considering Canadians played such a significant role in developing them.
According to Tim Wall, the most important thing CASP did in advancing the cause of
national suicide prevention was finding a champion. Two champions, in this case. Megan Leslie
and Harold Albrecht brought the issue of national suicide prevention to the parliamentary table.
CASPs petition supporting national suicide prevention was Canada-wide, and clearly
demonstrated Canadians belief in the importance of suicide prevention at the national level.
CASP has an entire page on their website dedicated to what interested citizens can do to support

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the cause of suicide prevention. The recommended activities include joining CASP, getting
involved in local suicide prevention efforts, writing or calling your local Member of Parliament,
councillor, or mayor, putting information about crisis and suicide support on your Facebook
page, learning about suicide and suicide intervention, volunteering at a local crisis line, and
talking directly about suicide. I have done many of these things as a volunteer and staff member
at Distress Centre, including learning about suicide and suicide prevention, signing a petition,
getting involved in local suicide prevention efforts, and talking openly about suicide in public
forums like Facebook and Twitter as well as in conversation with friends and family in crisis.
My first experience with suicide was as a young girl, when my neighbour took his own life using
a firearm. The issue was never discussed openly, but whispered in quiet conversation between
moms in the neighbourhood over coffee. I will continue to do what I can to inform others about
suicide and reduce the stigma in hopes that, when the word suicide is spoken in conversation
across Canada, it will not be whispered.

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References
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Alberta Mental Health Board. (2005b). Rates of suicides per 100,000 in Canada and Alberta.
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Canadian Association of Suicide Prevention. (2009). The CASP national suicide prevention
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