Official press release

A new report will better position government and its partners to help Nova Scotians at risk of attempting suicide.

The report, Suicide and Attempted Suicide in Nova Scotia, was released today, July 15. Its purpose is to help those who work in the areas of suicide prevention, intervention and support.

“Suicide is a very complex and sensitive public health issue,” said Dr. Robert Strang, Nova Scotia’s chief public health officer. “We need to talk about it more and better understand it to ensure the right programs and supports are in place to help Nova Scotians.”

The report describes the conditions surrounding suicide and attempted suicide in Nova Scotia. The data is based on hospital and vital statistics records of suicides and suicide attempts from 1995 to 2004. It examines demographic factors, how people attempt suicide and complete suicide, and the types of health-care services used by Nova Scotians at risk.

“This report is a baseline we can use to evaluate future efforts on this important issue, and we’ve made good progress since 2004,” said Dr. Strang. “We’ve developed a suicide prevention framework to reduce suicides and attempted suicides, we’re doing additional research with the medical examiner’s office, and we fund our community partners who work with Nova Scotians.”

Dr. Stan Kutcher, Sun Life Financial Chair in Adolescent Mental Health, a partnership with the IWK Health Centre and Dalhousie University, said that even though suicide and suicide attempt rates are decreasing, and Nova Scotia is experiencing lower suicide rates than most Canadian provinces, there is more to be done.

“Improving care for people with mental disorders, enhancing the capability of health care and education professionals to identify people at risk, promoting overall good health and resiliency, and improving access to good mental health care, can all help further reduce Nova Scotia’s suicide rates.”

Highlights of the report include:

• The rate of hospitalizations for suicide attempts declined by 30 per cent over the 10-year period
• 55 per cent of those hospitalized were female
• Lower income was associated with higher rates of both hospitalizations for suicide attempts and suicide deaths
• The rate of suicide death declined from 11 to nine individuals per 100,000
• Nova Scotia’s suicide rate was lower than the national average, nine out of 100,000 individuals compared to 11 out of 100,000
• 84 per cent of suicide deaths were male
• 55 per cent of suicide deaths were previously diagnosed with a mental disorder

The report is available online at www.gov.ns.ca/hpp.

There’s a lot of misinformation out there about youth suicide. Suicide rates in young people nationally have decreased by about 20% from the mid 1990’s to 2004. Nova Scotia is a good case study. It is difficult to determine trends in youth suicide in Nova Scotia because of the small numbers involved, but total suicide rates as well as total suicide attempts in this province have decreased substantially between 1995 and 2004.

Suicide in Canada, 1950 to 1992

Suicide in Canada, 1979-2003

Why this has occurred is not clear.

One explanation is that effective treatment of depression in young people may be an important factor. Studies have demonstrated a strong relationship between increased use of antidepressant medications and decreased suicide rates in youth. Evidence shows that both medications and psychological therapies decrease rates of suicide attempts in depressed youth. Recent research reports in both Canada and the USA indicate that when anti- depressant medication treatment in young people has decreased, suicide rates have increased. Treatment of depression in young people may effectively reduce suicide rates.

Association between suicide rate and SSRI use in youth 5-14 years old (Gibbons, et al. Am J Psychiatry 163:11, November 2006)

Suicide behaviour is complex. Not all self-harm behaviours are suicide attempts. Self-harm behaviour in young people may not be related to suicide, but rather to deficient problem solving strategies, difficulties with emotional control or impulsivity. It is only recently that we have understood the need to differentiate the two in how we collect data. Treatment for young people who demonstrate self-harm behaviours may be different than treatments for youth who attempt suicide.

Self-harm behaviours reflect many mental disturbances and may be an important vehicle by which young people can access emergency care. Thus, increases in self-harm emergency visits may not reflect an increase in suicide as has been erroneously suggested, but may reflect other phenomenon such as: greater parental awareness of the importance of immediately addressing these behaviors; difficulty in access to specialty mental health services; inadequate delivery of child and adolescent mental health care in primary care; inadequacies in the capability to provide early identification and interventions for youth at risk for mental disorders; or others.

Suicide in young people is a complex problem that requires thoughtful, evidence-driven approaches to appropriately address. It is also an emotional issue raising substantial concern amongst parents, youth, care providers, policy makers and the public alike. There are some interventions that we know work to decrease suicide rates in young people.

One of the most important is improving the early identification and effective treatment of depression in youth. This includes enhancing the competencies of primary health care providers (doctors, nurses, social workers, psychologists, etc) in the diagnosis and treatment of adolescent depression. Training programs for school personnel including “gatekeeper” programs for teachers and linkages between schools and health providers to facilitate identification, rapid assessment and effective treatment may also decrease youth suicide. Restriction of access to lethal means (such as bridge barriers) is helpful as is reasonable and informed media reporting.

Youth suicide is an important public health problem. We must work together to better understand it and to apply what we know works. We need to avoid inciting public anxiety through media reports that are not based on a solid understanding of the issue and we need to support the further development of easily accessible and effective mental health care – not just in hospitals but in schools and community settings. We need to do the right thing – not just do something!

~ Dr. Stan Kutcher

What does the face of a person with mental illness look like?

That question is at the heart of this year’s national anti-stigma campaign “Face Mental Illness,” which is the theme of Mental Illness Awareness Week (Oct. 5-11). In Canada, one in five people is living with a mental illness. Mental disorders are some of the most disabling medical conditions, with about 70 per cent of them onsetting prior to age 25. They exact a huge negative impact on health, society and our economy. Yet a strong and persistent stigma prevents thousands of adults and youth from accessing and receiving the help they need to get well and say well.

While the scientific understanding and treatment of mental disorders and the awareness of the importance of mental health in all aspects of life have advanced considerably in the past decade, the public perception of people with mental illness has been much slower to change. A recent national survey conducted by the Canadian Medical Association found extremely high rates of stigma against those who suffer from mental disorders, permeating all aspects of Canadian society. This stigma is largely present in our social structures and institutions – including our health, social services, education and justice sectors.

Stigma is essentially the polite word for discrimination. There is no room in our caring society for discrimination against those living with mental illness. There is no reason for those living with mental illnesses to be denied adequate housing or equitable health care or to spend their lives in the shadows.

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