SUICIDE PREVENTION AWARENESS 31ST ANNUAL COMMUNITY GUIDE Securing Our Community... Strengthening Our Commitment
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1 www.rnca.ca Suicide is a complex health issue that affects people of all ages, regardless of socioeconomic status, ethnicity or race. With increased awareness, reduced risk factors and enhanced protective factors, suicide is largely preventable. Globally, suicide is the ninth leading cause of death. Nationally, it is a leading cause of death in First Nations and Inuit communities and the second leading cause of death among youth aged 15 to 24 years old. Every day, 10 people in Canada die by suicide. The majority of these individuals were living with a mental health issue or substance use disorder. Our province has come a long way in improving the quality and availability of mental health and addictions services over the past several years, and yet, we know that there is still work to do. Government is committed to working with communities to improve awareness of mental health concerns, reduce stigma for seeking help and provide tools and supports needed to help people live healthy and well, thereby preventing deaths by suicide. Everyone should feel comfortable talking about their mental health and problematic substance use. More importantly, we want residents of our province to know they are not alone in their journey for wellness and support is available. Key ways to access support include, but are not limited to, the provincial CHANNAL pre-crisis Warm Line 1-855-753-2560, the provincial HealthLine (811), www.bridgethegapp.ca and Doorways drop-in counselling locations. For people who are experiencing a mental health or addiction emergency or crisis, please call 911 for immediate assistance which may include support from the provincial Mental Health Crisis Line and regional Mobile Crisis Response Teams. Together, we will continue to foster a culture of compassion and understanding to enable Newfoundlanders and Labradorians to live healthy and well. Sincerely, Hon. Andrew Furey Premier gov.nl.ca MESSAGE FROMTHE PREMIER
2 www.rnca.ca Proud to Support the Royal Newfoundland Constabulary Association for all their efforts in keeping our communities safe. TTS is an award-winning film and television production company with offices in St. John’s, Newfoundland and Toronto, Ontario.
3 www.rnca.ca Thank you to the residents and businesses of Newfoundland and Labrador for supporting our 31st Annual RNC Association Community Guide! Over the past 30 years, the generous support from citizens and businesses in our community has helped us to deliver valuable public safety information to the people of Newfoundland and Labrador. This year’s community guide focuses on “Suicide Prevention Awareness”. We are proud to support the Kids Help Phone in Newfoundland and Labrador with a portion of the proceeds from our community guide. The Kids Help Phone is Canada’s only 24/7 national support service which offers professional counselling, information and referrals, and volunteer-led text-based support to young people - in both English and French. Kids Help Phone assists young people through challenges or experiences they might face; including abuse and mistreatment. We hope that you find value in the information contained within this community guide and use it as a safety resource to discuss with your loved ones. On behalf of the Royal Newfoundland Constabulary Association Executive Board and its membership, thank you again for your support! Sincerely, Mike Summers President RNC Association “Supporting our Community…Strengthening our Commitment” PRESIDENT’S m e s s a g e
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5 www.rnca.ca 31st Annual Community Guide SUICIDE PREVENTION AWARENESS Suicide Prevention Awareness RNCA News & Photo Album Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Suicide in Canada: Key Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Suicide in Canada – an overview of infographic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Teens talk, but is Canada listening? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 I’m Having Thoughts of Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 I’m Concerned About Someone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Factors that increase the risk of suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Suicide among Indigenous Peoples in Canada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Safe communication for suicide prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Talking to Children About a Suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 When a Parent Dies by Suicide ... What kids want to know . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 What is intervention? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Safety plans to prevent suicide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Youth story: On barriers to seeking mental health resources . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Journey to hope: Alicia Raimundo’s story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Dani’s story of grief, hope and the power of compassion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Community Addictions Prevention and Mental Health Promotion Grants Awarded . . . . . . . . . 85 Where to get help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 World Suicide Prevention Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 RNCA supports Kids Help Phone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Donations to the Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 NL Police and Peace Officers’ Memorial Ceremony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Detective Sgt. Thomas Fraize Scholarship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Congratulations to the Recruit Training Program Class of 2020 . . . . . . . . . . . . . . . . . . . . . . . 101 Presentation to the RNCVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Big Brothers Big Sisters – Mask Up for Mentoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 RNC Adopt a Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 ADVERTISERS’ INDEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110 Need help but don’t know where to start? Contact ‘211’ . . . . . . . . . . . . . . . . . . . . . . . . . . 128 RNCA Messages Message from the Premier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Message from the RNCA President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 RNCA Executive Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Publisher’s Message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
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7 www.rnca.ca EXECUTIVE BOARD “Supporting our Community…Strengthening our Commitment” Supporting Suicide Prevention Awareness Staff Sergeant Mike Summers President Cst. Nick Cashin 1st Vice President Sgt. Jeff Thistle 2nd Vice President Cst. Justin Dawe Treasurer Cst. Robyn Knight Secretary Cst. Eric Learning Director, CID Cst. Patrick McDonald Director, Support Services Sgt. Russ Moores Director, NCO Cst. Danny Abbass Director, Corner Brook Cst. Bernard Morgan Director, Labrador Cst. Geoff Hall Director, Platoon A Cst. Chris Olford Director, Platoon B Cst. Michael Hoddinot Director, Platoon C Cst. Kevin Hogan Director, Platoon D
8 www.rnca.ca St. John’s. Bay Roberts. Marystown. Clarke’s Beach. Gander. Grand Falls-Windsor. Corner Brook. We inspire financial confidence.
9 www.rnca.ca On behalf of the Royal Newfoundland Constabulary Association, I would like to take this opportunity to sincerely thank each and every advertiser and sponsor of our Annual Telephone Appeal, allowing this unique publication to be distributed throughout the community, to schools, libraries and public facilities and also available online at www.rnca.ca, making it easily accessible to everyone. The RNCA publishes an Annual Crime Prevention Guide to educate the public on important community concerns. This 31st Annual Crime Prevention Guide targets the subject of Suicide PreventionAwareness and is designed to help prevent suicides by recognizing the signs and behaviors of children and adults that may be at risk. This publication is made possible as a result of financial support from residents and business representatives throughout the province. With their generous support for the activities of the Royal Newfoundland Constabulary Association, the RNCA is also able to give back to their communities through donations to various local charities and programs for youth, such as their recent $2,500 donation to KIDS HELP PHONE, which provides 24/7 support and counselling to help young people get the help they need. Last year, young people in Newfoundland and Labrador reached out to the Kids Help Phone over 28,000 times, which is 10,000 more contacts than in 2019, as a result of COVID-19 challenges. We welcome comments or suggestions regarding these publications and always look forward to speaking with you each year during our Annual Telephone Appeal. Respectfully, Mark T. Fenety President Fenety Marketing Services PUBLISHER’S MESSAGE “Providing quality, professional marketing and fundraising services on behalf of high-profile, non-profit organizations.” WWW.FENETY.COM
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11 www.rnca.ca Suicide Suicide is a troubling topic that most of us would rather not deal with, but suicide is a reality, and it is more common than we would like to think. - More than 3,500 Canadians kill themselves each year. - 1 in every 25 Canadians attempts suicide during his or her lifetime. - A 1994 United Nations study over a three-year period found Canada’s suicide rate for children and youth under 21 to be among the highest in the world. Many times suicidal actions are a desperate “cry for help” and many suicides can be prevented. By paying attention to warning signs and talking about the “unthinkable,” you may be able to prevent a death. Why do people take their own life? Most people who attempt suicide are ambivalent about taking their own life, however circumstances make them feel that life is unbearable. Suicide seems like the only way to deal with their problems because they have an extreme sense of hopelessness, helplessness and depression. Some of the factors that may lead a person to attempt suicide are: - feelings of isolation - having a serious physical illness - experiencing a major loss (death of a loved one, unemployment or divorce) - abuse of drugs or alcohol - experiencing major changes in life - prolonged depression with alterations in thinking patterns - post-partum depression - history of severe child abuse - living in a violent relationship What are the danger signs? Some people who kill themselves do not give any warning at all. Many, however, offer clues and communicate their plans to others. Individuals expressing suicidal intentions should always be taken seriously. Some of the signs to look out for are: - direct suicide threats such as “I want to die,” or indirect threats such as “You would be better off without me” - personality changes or withdrawn behaviour - hoarding medication - giving away prized possessions - lack of interest in future plans - isolation from friends and colleagues - depression Threats that may signal imminent danger often come from people who are isolated, who have attempted suicide before (and then were discovered only by accident), are impulsive, and have access to lethal means (weapons, drugs). (continued)
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13 www.rnca.ca What can you do to help prevent a suicide? Suicide is a taboo subject yet talking about it openly is helpful. A person contemplating suicide needs the support of people who listen and care. If you are concerned that someone you know may be suicidal, take action: - find a place to talk where the person feels comfortable, they need to know that you respect their need for privacy - encourage the individual to express their feelings freely - the single most important thing you can do is to listen attentively without judgment - ask them whether they have considered suicide - bringing up the subject will not cause them to act upon it - talk to them about your concern and fears - they need to know that someone cares - ask whether there is anything you can do - talk about the resources that can give them support - family, friends, clergy, counselling or psychiatric treatment - let them know that you are there to support them, but also know your limits - you cannot do it alone What can you do if you are feeling suicidal? It may seem like there is no light at the end of the tunnel, and asking others for help and discussing your feelings can seem like a daunting task. If you reach out however, you will discover that there is help and that you are not alone. Many people have felt suicidal when facing difficult times and have survived, returning to normal lives. If you have these feelings you should: • talk to a trusted friend or family member about your feelings • call a crisis telephone support line • talk to your family physician; he or she can arrange for counselling and/or prescribe medication • get involved in a self-help group and talk to people who have “been there” • understand that you are not in the best shape to make major decisions See page 87 for a list of resources where you can get help! reachoutnow.ca Suicide (continued) www.freepik.com/photos/Business photo created by jcomp
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16 www.rnca.ca www.shoppersdrugmart.ca Proud Sponsors of the RNC Association 31st Annual Community Guide, Suicide Prevention Awareness MDI Contracting is a locally owned & operated multi-service commerical diving company with its base on the Avalon Peninsula, Newfoundland & Labrador, Canada.
17 www.rnca.ca Suicide in Canada – an overview of the infographic on page 15 An average of 10 people die by suicide each day in Canada. Of the approx. 4000 deaths by suicide each year, more than 90% were living with a mental health problem or illness. Suicide is the 9th leading cause of death in Canada. 1. Cancer 6. Diabetes 2. Heart disease 7. Alzheimer’s disease 3. Stroke 8. Influenza + pneumonia 4. Respiratory disease 9. Suicide 5. Unintentional injuries 10. Kidney disease Across the life span Children and youth (10 to 19 years) - Suicide 2nd leading cause of death - Males account for 41% of 10-14 year old suicides, increasing to 70% of 15-19 year olds - Self-harm hospitalizations 72% females Young adults (20 to 29 years) - Suicide 2nd leading cause of death - Males account for 75% of suicides - Self-harm hospitalizations 58% females Adults (30 to 44 years) - Suicide 3rd leading cause of death - Males account for 75% of suicides - Self-harm hospitalizations 56% females Adults (45 to 64 years) - Suicide 7th leading cause of death - Males account for 73% of suicides * Highest suicide rate across lifespan observed among males 45 to 59 years - Self-harm hospitalizations 56% females Seniors (65+ years) - Suicide 12th leading cause of death - Males account for 80% of suicides *Males aged 85+ experience the highest rate of suicides among seniors -Self-harm hospitalizations 52% females For every 1 suicide death there are: 5 self-inflicted injury hospitalizations 25-30 attempts 7-10 people profoundly affected by suicide loss www.canada.ca See page 87 for a list of resources where you can get help!
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31 www.rnca.ca I’m HavingThoughts of Suicide There are many crisis centres available 24 hours a day to talk to you. Thoughts of suicide can sneak up on some people when they are not expecting it. For others, they can come and go and still for others, they always seem to be in the back or front of their mind. If you are experiencing suicide-related thoughts, you need to know that you’re not alone. By some estimates, as many as one in six people will think seriously about suicide at some point in their lives. WHAT YOU NEEDTO KNOW ABOUT SUICIDE RELATED THOUGHTS Suicide-related thoughts can mean different things for different people.They can be an early warning sign that a person is under a lot of stress and worry. They can be the result of intense feelings that a person doesn’t know how to name or how to cope with. For others, suicide related thoughts can be tied to a diagnosed mental illness such as a major depression, posttraumatic stress disorder, an anxiety disorder, schizophrenia, or substance use. Having these thoughts can be scary for some and for others, may be perceived to be a comfort as they believe that it may offer a choice or some control when things feel overwhelming and insurmountable. When thoughts of suicide arise, know that “your brain is not your friend”.We know that the intensity of the feelings and thoughts interfere with a person’s ability to problem solve. Living and dealing with these thoughts can be helped through treatment. It’s not easy and still, neither the thought nor the feelings will end a person’s life; it’s what you do with those thoughts and feelings. Treatment is not one size fits all. Different treatments work better for some people and at different times in their lives. If you find you are thinking of suicide and can’t think your way out of those thoughts, reach out to a friend, a family member, clergy member, crisis line, therapist or counsellor. They may help you see alternatives, even if just for the time being, to help you keep yourself safer. Will the thoughts go away? The intensity of thoughts of suicide will wax and wane and for some, they may experience these thoughts only once in their lifetime. There can be moments or even days or years of comfort, relief, contentment, even humour or joy, in the midst of experiencing thoughts and feelings that in the moment seem to “never go away”. An example might be that even if my life is falling apart, I can still smile when I eat my favourite food while petting my cat. I can go on a vacation or a day trip and get some relief from the intensity of the thoughts, for the time being. Reasons for living or engaging with possibilities of a future can help manage the current pain. If you are experiencing thoughts of suicide, it’s hard to think of the big picture of a future.That’s because your brain has engaged in what is called “constricted thinking”. Break it down into smaller chunks. “Future” might mean until the next commercial, an hour, a day, a month, or a year. Some people find it helpful to have pictures of people they care about or who care about them; a card or letter from someone important to them; a poem, painting, or song, nearby to remind them they are cared about. Some people find distraction activities helpful, a crossword puzzle, word search, movie, online games, exercising or dancing are some ideas. Do not keep suicidal thoughts to yourself! By sharing your thoughts with someone who can hear your distress, you are no longer holding “the secret” alone. There is no shame to thoughts of suicide. The thoughts are giving you important information that all is not well. There are people who are willing and able to help.Talk to someone, a friend, therapist, clergy member, family member, or teacher and let them know you are wanting their help because the situation feels so horrible. If the first person you try to talk to doesn’t get it, try someone else. Not everyone has the skills and where some people are good at “doing” things, others are good at listening. Pick someone or a resource you think will be best at the moment. See page 87 for a list of resources where you can get help! suicideprevention.ca
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33 www.rnca.ca I’m Concerned About Someone What you can do when you’re concerned. Never agree to keep thoughts of suicide a secret. Sometimes instinct tells us we have to break confidentiality. It’s better to have someone alive and mad at you than dead by suicide and you feeling that you missed an opportunity to help them keep safe. We recommend treating this subject and the people involved with respect, dignity and compassion and don’t keep it to yourself. Know who you can connect with as this work cannot be done alone. You may, as a helper, experience thoughts and feelings that are uncomfortable. It’s OKAY to reach out. Talking about suicide can provide tremendous relief and being a listener is the best intervention anyone can give. Talking about suicide will not cause suicide. When experiencing intense emotions, the person will not be able to problem solve. It is not your job to fix their problems. Listen, care, validate and be non-judgmental. Questions to Consider when you’re concerned: • Are you thinking of suicide? • Have you tried to end your life before? • Have you been feeling left out or alone? • Have you been feeling like you’re a burden? • Do you feel isolated and or disconnected? • Are you experiencing the feeling of being trapped? • Has someone close to you recently died by suicide? • How are you thinking of ending your life? • Do you have the means to do this (firearms, drugs, ropes)? • Have you been drinking or taken any drugs or medications? • How have you been sleeping? • Are you feeling more anxious than usual? •Who can we contact that you feel safe and/or comfortable with? For the helper: • Are you noticing or have you noticed any dramatic mood changes? • Changes in work behavior or school attendance/marks dropping? • Does the person seem to be out of touch with reality? What areWarning Signs? Suicide prevention depends heavily on our ability to recognize people who are in distress and may be at risk. The American Association of Suicidology developed a simple tool that we can all use to remember the warning signs of suicide. This tool is called “IS PATH WARM” and outlines the key points to remember. Suicide is preventable. Help is available. There is hope. Know Suicide Warning Signs. Ideation (Suicidal Thoughts) I Substance Abuse S Purposelessness P Anxiety A Trapped T Hopelessness/Helplessness H Withdrawl W Anger A Recklessness R Mood changes M (continued)
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35 www.rnca.ca I’m Concerned About Someone (continued) How to be HelpfulWhen Someone is Having Suicide-RelatedThoughts • Take all threats or attempts seriously • Be aware and learn warning signs of suicide • Be direct and ask if the person is thinking of suicide. If the answer is yes, ask if the person has a plan and what the time line is. • Be non-judgmental and empathic • Do not minimize the feelings expressed by the person • Do not be sworn to secrecy …seek out the support of appropriate professionals • Ask if there is anything you can do • Draw on resources in the person’s network • Do not use clichés or try to debate with the person • In an acute crisis take the person to an emergency room or walk in clinic or call a mobile crisis service if one is available • Do not leave them alone until help is provided • Remove any obvious means e.g. firearms, drugs or sharp objects) from the immediate vicinity See page 87 for a list of resources where you can get help! Source: International Association of Suicide Prevention
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37 www.rnca.ca Factors that increase the risk of suicide No single cause can explain or predict suicide.Thoughts of suicide or suicide-related behaviours are a result of a combination of personal, social and cultural factors.The presence of these factors is different from person to person over their lifetime. Factors that may increase the risk of suicide include: • a prior suicide attempt • mental illness like depression • a sense of hopelessness or helplessness o this means that you believe your life or current situation won’t improve • misuse of alcohol or substances • chronic (long-term) physical pain or illness • trauma, for example: o violence o victimization, like bullying o childhood abuse or neglect o suicide by a family member or friend o events that affect multiple generations of your family Other factors that can increase the risk of suicide include: • significant loss, including: o personal (relationships) o social o cultural o financial (job loss) • major life changes or stressors, such as: o unemployment o homelessness o poor physical health or physical illness o the death of a loved one o harassment o discrimination • lack of access to or availability of mental health services • personal identity struggles (sexual, cultural) • lack of support from family, friends or your community • sense of isolation What helps to prevent suicide There are a number of things that can help to guard against suicide, including: • positive mental health and well-being • a sense of hope, purpose, belonging and meaning • social support • healthy self-esteem and confidence in yourself • asking for help if you’re having thoughts of suicide • a sense of belonging and connectedness with your: o family o friends o culture o community Other ways to help protect against risk of suicide include: • a strong identity (personal, sexual, cultural) • access to appropriate mental health services and support • good coping and problems-solving skills, and the ability to adapt to change and new situations • supportive environments where you’re accepted and valued (school, workplace, community) • positive relationships (peers, family, partner) If you’re struggling with your mental health or are worried about someone, you’re not alone. See page 87 for a list of resources where you can get help! www.canada.ca
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39 www.rnca.ca Suicide among Indigenous Peoples in Canada Article by Allison Crawford, Published Online September 22, 2016 First Nations in Canada have suicide rates double that of the national average, and Inuit communities tend to have even higher rates. Suicide in these cases has multiple social and individual causes.To date, there are a number of emerging programs in suicide prevention by Indigenous organizations that attempt to integrate Indigenous knowledge with evidence-informed prevention approaches. This article contains sensitive material that may not be suitable for all audiences. In the spring of 2016, Attawapiskat First Nation in Ontario declared a state of emergency after 11 young people tried to end their lives by suicide.The news story made national headlines, but this was not the first or only suicide crisis among Indigenous peoples in Canada in recent years. According toThe Human Face of Mental Health and Mental Illness in Canada, a 2006 report by the Public HealthAgency of Canada, First Nations in Canada have suicide rates double that of the national average, and Inuit communities tend to have even higher rates (six to 11 times the Canadian average). A report from Statistics Canada for the period 2011 to 2016 revealed that the rate among First Nations was three times higher than among the non-Indigenous population; the rate was 1.6 times higher among Métis and nine times higher among Inuit communities. Suicide in these cases has multiple social and individual causes, including social inequity such as poverty and lack of access to healthcare; history of childhood adversity including physical and sexual abuse; historic and ongoing loss of cultural identity; and psychological distress and substance use. Suicide affects not only individuals and Indigenous communities but Canada at large. To date, there are a number of emerging programs in suicide prevention by Indigenous organizations that attempt to integrate Indigenous knowledge with evidence-informed prevention approaches. Rates of Suicidal Behaviour Suicidal behaviours are intentional thoughts and actions aimed at ending one’s life.They generally include thinking about suicide, inflicting self-harm or attempting suicide, which may result in death. In Canada, approximately 11 people die by suicide every day. Suicide is also a global public health problem; in 2012, for example, approximately 804,000 people in the world died by suicide. For young and Indigenous people, the problem is especially pronounced. Suicide is the second-leading cause of death globally for people aged 15 to 29. Indigenous populations in many areas of the world also have the elevated rates of suicide - including inAustralia, New Zealand, Greenland, the United States and Canada. Some First Nations, Inuit and Métis communities in Canada have much higher rates of suicide than the general Canadian population, although it is important to note that some communities have rates that are similar to the national average. Suicide among First Nations youth (aged 15 to 24 years) across Canada is five to six times higher than among non-Indigenous peoples.These elevated rates are seen in males and females, although higher among males.According to a 2000 report by the Canadian Institute of Health, the rate of suicide among First Nation males was 126 per 100,000 (compared to 24 per 100,000 non-Indigenous males), while it was 35 per 100,000 for females (compared to 5 per 100,000 non-Indigenous females).Data from 2011 to 2016 shows an average rate of 29.6 per 100,000 for First Nations males and 19.5 per 100,000 for First Nations females.Recent data gathered by Inuit Tapiriit Kanatami for Inuit living in Northern Canada showed elevated rates in all regions, with Nunatsiavut in Labrador experiencing suicide at rates 25 times higher than the rest of Canada. Rates for Inuit youth in some areas are up to 40 times the national average. It also appears that many Indigenous peoples in Canada think about suicide more often than non-Indigenous Canadians. Nearly one quarter of First Nations people think about suicide at some point in their life.This also applies to Indigenous people living off-reserve; according to Statistics Canada data from 2012, 21 per cent of First Nations men and 26 per cent of First Nations women living off-reserve have suicidal thoughts, compared with 11 per cent of non-Indigenous men and 14 per cent of (continued)
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41 www.rnca.ca non-Indigenous women who had similar thoughts. The 2007-08 Inuit Health Survey also showed that 29 per cent of Inuit have attempted suicide in their lifetime and 48 per cent have thought seriously about suicide. For Métis, thoughts of suicide are higher than non-Indigenous peers, particularly for women. Causes of Elevated Suicide Rates The causes of suicide involve a number of different factors, including social stressors (i.e., stressful life events) and biological, familial, psychological and community factors. (See Figure 1.) Usually, any individual who engages in suicidal behaviour experiences more than one of these factors. Causes of suicide can be separated into protective factors (i.e., conditions or attributes that assist in coping or preventing stresses) including resilience, which can buffer risk for suicide even amidst a great deal of adversity, and distal factors (i.e., predisposing factors), including poverty, genetics or a history of childhood maltreatment. Childhood abuse can cause suicidal behaviours into adulthood, which can be precipitated by certain stressful or tragic events, such as loss. Figure 1. Suicide Risk Factors Risk factors at multiple levels create increased risk for suicide at a community level and can set individuals on pathways of cumulative risk that lead to suicidal behaviour. Individual Risk Factors In the general Canadian population, risk for completed suicide is highest among males, aged 50 to 54 years old, particularly those who have depression, are socially isolated and have chronic medical problems. Psychological autopsies gather information on those who have completed suicide in order to understand these risks. These studies show high rates of mental illness, including depression; misuse of substances, such as alcohol, which can increase impulsive behaviour; and multiple recent stressors, such as loss. Recent evidence demonstrates that there may be two groups of people who engage in suicidal behaviour: a group that is younger than 26 years of age at first attempt and tends to have a history of childhood adversity, including physical and emotional abuse and cannabis misuse; and a group that is older than 26 years of age at first attempt, characterized by depressive disorders. Among Indigenous peoples in Canada, risk for suicide is highest in young people, particularly males. Many of the same risk factors for the general population are related to suicidal behaviour among Indigenous youth, such as depression and substance misuse.There is also evidence of the predisposing risk factors that affect other young people with elevated rates of suicide, especially early developmental adversity, such as trauma and abuse, including childhood sexual abuse.This early adversity can create a pathway of cumulative risk, from legal problems and challenges in relationships, to mental health issues and substance misuse. Access to the means of suicide may further increase risk. Many Indigenous youth who attempt suicide do so by hanging. Firearms are also a frequent means of suicide. It is difficult at times, especially in terms of hanging, to limit access to the materials used in suicide attempts. Social and Historical Factors Attention to individual risks can distract from comprehending the larger social and historical reasons for elevated suicide rates among some Indigenous communities in Canada. Suicide happens in a larger social context and is a marker of social and community distress. There is no evidence that Indigenous groups in Canada have historically elevated rates of suicide within their cultures. This is evident among Inuit, who have seen a steady increase since the 1980s compared, historically, with low rates of suicide. These patterns compel us to look for wider social explanations, such as the colonial context of settling Indigenous populations into reserves and settlements, and governmental policies surrounding education, social welfare, justice and policing.The Royal Commission on Aboriginal Peoples, established in 1991, documented the impact of many of these policies, stating: Our central conclusion can be summarized simply: The main policy direction, pursued for more than 150 years, first by colonial then by Canadian governments, has been wrong. Suicide among Indigenous Peoples in Canada (continued) (continued)
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43 www.rnca.ca Successive governments have tried - sometimes intentionally, sometimes in ignorance - to absorb Aboriginal people into Canadian society, thus eliminating them as distinct peoples. Policies pursued over the decades have undermined - and almost erased - Aboriginal cultures and identities. Direct consequences of colonial settlement are a decrease in the autonomy of Indigenous peoples and disruption to traditional knowledge, language and ways of life. Preserving or regaining autonomy, language and culture can be protective against suicide within some communities.The First Nations Regional Health Survey (FNRHS), for example, showed that there were lower rates of suicidal thoughts and attempts among those who had intermediate or fluent knowledge of their Indigenous language. In families and communities that have been most impacted, on the other hand, cultural loss resulted in historical trauma that may continue across generations, affecting even younger generations that did not experience these disruptions within their lifetime. Research with the children and grandchildren of residential school survivors, for example, reveals that these generations have a higher incidence of psychological distress and suicidal behaviours compared with their peers whose parents or grandparents did not attend residential school.Traumatic losses of loved ones and exposure to suicide among community members and peers adds to community and family grief, and contributes further risk for suicide among youth. Many of these historical disruptions and abuses have resulted in ongoing social distress, which is compounded by wider socio-economic and health inequities. Social factors, such as income and education, are known to influence the overall health and wellness of people, including their risks for suicide. Indigenous peoples across Canada experience lower educational achievement and income, higher unemployment, food scarcity, poor access to housing and more barriers to accessing health care compared with the general population.These inequities can contribute to higher rates of many medical conditions, such as diabetes and infectious diseases, which, in turn, influence mental wellness. FNRHS found higher rates of depression, suicidal thoughts and suicide attempts among those who also have a chronic medical illness. It also found that individuals who reported higher levels of stressors, such as low socio-economic status, and being subject to instances of aggression and racism, reported being moderately or highly distressed more often than those who did not. Suicide Intervention and Prevention Addressing the risks for suicide that exist at these multiple levels and that impact both individuals and the community as a whole, requires multi-level approaches that reduce risk and also build in protection and resilience. Suicide prevention and mental wellness require investments beyond mental health care. Given the historical losses that resulted in loss of autonomy for many Indigenous communities, it is of key importance that efforts to address suicide are led by Indigenous peoples and target the community as well as the individual. Prevention and intervention should draw on the values, knowledge, strength and resilience of Indigenous peoples. There is a growing wave of Indigenous youth who prefer to talk of life promotion, focused on building strength and meaning among youth instead of what they perceive as a deficits-based approach to suicide prevention. There are also, however, many emerging programs in suicide prevention by Indigenous organizations that continue to draw on global best-practices in suicide prevention, while integrating those with their own practices and settings, making them more resonant with Indigenous world views. Examples of this include programs led by elders or knowledge keepers, programs that incorporate ceremony and cultural teachings, are led in Indigenous languages, or that occur on the land. Regardless of the approach, most practitioners in this field acknowledge the need to evaluate the effectiveness of interventions to add to Indigenous knowledge in this area and to ensure that the most effective solutions are found. One of the most promising areas in suicide prevention by Indigenous groups, both globally and within Canada, is the development of suicide prevention strategies. One of the first national Canadian approaches is the National Inuit Suicide Prevention Strategy developed by Inuit Tapiriit Kanatami. There is evidence that suicide prevention strategies themselves reduce suicide through advocacy, focusing resources towards priority areas, integrating services and creating accountability. Indigenous-led strategies can ensure that the focus is specific to the needs and values of the Indigenous group. These strategies can also ensure that a holistic approach is taken, understanding the need to reduce risk and build resilience throughout an individual’s life, while also addressing the wider social context, building equity for all and restoring community autonomy and cohesion. www.thecanadianencyclopedia.ca Suicide among Indigenous Peoples in Canada (continued)
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45 www.rnca.ca Safe communication for suicide prevention Using language that is helpful and respectful encourages an environment free of stigma, where we can talk more openly and safely about suicide and its prevention. Words matter in a world where silence or insensitivity can make matters worse. The more we are open and safe in our communication, the more likely it is that people can offer or seek help. Put people first Using people-first language avoids stigmatizing words or phrases and emphasizes people while respecting differences and experiences, rather than referring to their actions, conditions, or diagnoses. People-first language: • People with (…mental illness, depression, addiction, etc.) • Person who has died by suicide • Person thinking about suicide • People who have experienced a suicide attempt Problematic language: • These/those people, the mentally-ill, the depressed, addicts, etc. • Suicide victim, suicidal, contemplators, attempters Helpful tips: •Wherever possible, avoid the use of labels and acronyms when referring to or addressing people. • Use neutral and inclusive words and phrases to respect people and their experiences. • Carefully consider the choice of words around the issue of suicide and people. Depending on the audience (context, preference or culture) alternative language may be appropriate. The term survivor (e.g. survivors of suicide loss, suicide attempt survivor) may not resonate with everyone.The phrase ‘people impacted by suicide’ is generally considered more neutral and inclusive. Other examples of people-first language • People bereaved by suicide • Person impacted/affected by suicide • People with lived experience related to suicide Use safe language It is important that language about suicide is careful and factual. When we replace problematic language with neutral and respectful language, we help shift how society reacts to and understands suicide. We can make the conversation about suicide safer. Safe language: • Die by suicide • Died by suicide • Death by suicide • Suicide attempt • Attempted suicide • Populations with higher rates of suicide • Populations with potentially high risk for suicide • Factors that may increase people’s risk for suicide • Social and economic costs associated with suicide Problematic language: • Commit suicide • Committed suicide • Successful suicide • Completed suicide • Failed suicide • Failed attempt • Unsuccessful attempt • Incomplete suicide • High-risk people/ populations/groups • At-risk • Vulnerable or susceptible • Those people/populations/groups • Burden of suicide The term ‘committed’ is stigmatizing as it implies someone is criminal or immoral or has committed an offence. Suicide is not a crime. It was decriminalized in 1972. Recent amendments to the Criminal Code of Canada (section 241) refer to die by suicide rather than ‘committed suicide’. Suicide is a tragic outcome of many complex factors with lasting impacts; it is never about success or failure. It is not something to achieve or finish like a task or project. (continued)
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