Preventing Despair

I have learned over a lifetime of personal and professional relationships that suicide and the thought of ending one’s own life is a complex and heartrending experience.   I don’t know how many people have shared with me their belief that suicide was a real choice for them - possibly hundreds. A belief that arose from despair and hopelessness.

Responding to suicidal ideation or behaviour in the moment, through initiatives such as Help Lines or peer support, is different than helping people to no longer consider suicide as an option at difficult times in their lives.  And this is different again than preventing, or at least reducing the incidence of, suicide in our society as a whole. Or as the final statement in the recently released Suicide Prevention Strategy The Building Blocks of Hope describes it: “make Prince Edward Island safer from suicide”.  

In spite of the hope that the report’s over 60 recommendations will prevent suicide on PEI, I’d suggest that these recommendations are not designed to accomplish that goal, and that the Strategy is wrongly named.  The concerned and affected Islanders who worked to develop this Strategy deserve appreciation and acknowledgement for tackling this complex issue. However, it would more aptly be called a Suicidal Ideation Response Strategy.  The model of HEAR, HELP, and HEAL that is presented is a response model, not a prevention model. The recommendations, with few exceptions, address how to respond to Islanders who are considering suicide or who have had a family member complete a suicide.  And don’t misunderstand my intent, this is very important work that needed to be done. In fact, recommendations such as integrating Social Emotional Learning into our education curriculum, tracking data, a single electronic health record system, and training ER staff in mental health are welcome and long overdue.  I sincerely hope that this report is followed by recommendations for how it will be implemented, funded, staffed, monitored, evaluated, and integrated into the existing Mental Health Strategy.

However, this is a Response Strategy because, in spite of a one page mention of the Social Determinants of Health (SDH) and the recognition that “It is imperative that the implementation of any suicide prevention strategy is done with strong consideration paid to recognizing and addressing the disparities within the social determinants of health”, the recommendations offered in  the report do not address these underlying social determinants nor the contributors to despair and hopelessness. Consideration of which must be made in order to make a real and sustainable difference in the lives and health of Islanders - to make them “safe from suicide”. This is well articulated in the recent Health in All Policies motion from the Leader of the Third Party. (http://www.assembly.pe.ca/progmotions/motions/653/40.pdf)

With very few exceptions, the people I have had the privilege to know who have seriously considered suicide, seriously attempted to end their lives through suicide, or who have completed suicides, have histories of childhood trauma, violence, loss, grief, isolation, unemployment, discrimination, or poverty. My clinical and personal observations are supported by the extensive research literature on the link between the Social Determinants of Health and suicide.  If we want to develop and implement a truly preventative Strategy in any area of mental health and wellness, including suicide, it is these underlying determinants that we must focus on.  

Otherwise,  we are not building a real possibility for sustainable, life changing, hope.  

Susan Hartley is the Green Party of PEI's Shadow Critic for Health & Wellness