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Ten years have passed since the idea of a federal framework for suicide prevention was realized through the adoption of the Federal Framework for Suicide Prevention Act. This Act required the Government of Canada to develop such a framework—an obligation that was fulfilled in 2016 with the release of the Federal Framework for Suicide Prevention (the Framework). The Framework’s stated mission is to “prevent suicide in Canada” however, there has been no significant change to the suicide rate in Canada since the Framework has been in place. In fact, for the Canadian population as a whole, the suicide rate has remained largely stable over the past 20 years. This seemingly stable rate obscures the overrepresentation of some populations—Indigenous peoples, and more specifically Inuit; and boys and men.

It is evident that the success of the Framework remains limited. The Standing Senate Committee on Social Affairs, Science and Technology (the committee), therefore, undertook a study to evaluate the effectiveness of the Federal Framework for Suicide Prevention, hearing from the Minister of Mental Health and Addictions, medical experts and clinicians, advocates and persons with lived and living experience with suicide. The Minister of Mental Health and Addictions informed the committee that work is being done to update the Framework and therefore, a major theme throughout the study was identifying how an updated Framework could be strengthened.

While this study aimed to evaluate the Framework, the committee acknowledges that in many ways, the Framework is intertwined with the broader topic of suicide prevention in Canada, and thanks witnesses who shared information on that topic as well. Given that the committee has not yet had the opportunity to study such an important subject at the level of detail it requires, this report is divided into two parts. The first part evaluates the Federal Framework for Suicide Prevention and provides recommendations for its improvement. The second part provides a summary of the testimony shared with the committee about suicide prevention more generally.

RECOMMENDATION 1

That the Government of Canada commit to updating the Federal Framework for Suicide Prevention to produce an approach that effectively works at preventing suicide in Canada, and prioritize:

– identifying and promoting evidence-based public health and clinical interventions that are known to have a meaningful impact on suicide in Canada (measured through decreased suicide rates and/or decreased hospital visits due to suicide attempts), such as means restriction;

– moving away from supporting interventions and programs that are not evidence-based;

– replacing concepts of “hope and resilience” in the Framework with “meaning and connectedness;” and

– providing programming based on data that measures the impact of suicide prevention interventions, specifically: suicide rate, number of emergency room visits associated with a suicide attempt and number of hospitalizations associated with a suicide attempt.

RECOMMENDATION 2

That the Government of Canada establish specific priorities in the updated Framework, namely:

– identifying local public health and clinical health interventions that are demonstrated to be effective, and scaling them nationwide;

– targeting populations that are currently overrepresented in Canada’s suicide rates: First Nations, Métis and Inuit; boys and men; racialized communities; and persons with mental illnesses; and

– funding research into promising initiatives for suicide prevention.

RECOMMENDATION 3

That the Government of Canada establish an independent critical review of revenue-generating suicide prevention and intervention programs operating in Canada; and that the results of this review be appended to the Framework.

RECOMMENDATION 4

That the updated Framework require that comprehensive Gender-based Analysis Plus training be added to the existing body of clinical and professional suicide prevention and treatment training, resources and development instruction provided to healthcare providers, so as to ensure that public health and clinical intervention treatments respond to the particular cultural, historical, socio-economic contexts and related contributing gendered factors that are distinct, given the diversity of individuals and groups in need of care.

RECOMMENDATION 5

That the Government of Canada collaborate with provinces, territories and civil society organizations to improve national suicide and suicide prevention data collection and analysis by:

– creating a national database on a) suicide, including indicators such as suicide rate, number of emergency room visits associated with a suicide attempt and number of hospitalizations associated with a suicide attempt; b) effective suicide prevention programs and research; and c) contributing and causal factors for suicide identified through GBA Plus;

– standardizing coroners’ reports;

– collecting sufficient demographic and geographic data for disaggregated analysis; and

– collaborating with provincial and territorial authorities on making suicide and suicide attempts incidents reportable to a specific authority.

RECOMMENDATION 6

That the Public Health Agency of Canada improve its reports on progress related to the Framework by establishing meaningful measurable outcomes and by evaluating suicide prevention programming against these benchmarks.

RECOMMENDATION 7

That the updated Framework explicitly acknowledge the additional challenges faced by certain populations in Canada—rural, remote and Northern communities; English- and French-second-language speakers; refugees and immigrants; persons with disabilities; racialized communities—in accessing mental healthcare, and provide resources and programming to mitigate these challenges; and, that the updated Framework acknowledge the high level of stigma attached to suicide, and respond by supporting mental healthcare access in all communities.

RECOMMENDATION 8

That the Government of Canada return to the Standing Senate Committee on Social Affairs, Science and Technology to share the updated Federal Framework for Suicide Prevention.

RECOMMENDATION 9

That the updated Framework acknowledge the crisis of Indigenous overrepresentation in Canada’s suicide rate, and:

– recognize the expertise and knowledge of community members by engaging directly with Indigenous experts with lived and living experience in suicide prevention;

– integrate life promotion into suicide prevention models;

– provide flexible financial support for programming that can be devised and managed by community members autonomously;

– create programming designed to train Indigenous community members in mental healthcare and intervention; and

– ensure a trauma-informed, culturally-appropriate approach when providing care to Indigenous peoples.

RECOMMENDATION 10

That the updated Framework acknowledge the overrepresentation of boys and men in Canada’s suicide rate, and:

– recognize that men and women may require different forms of therapeutic interventions;

– target research towards treatment innovations for boys and men; and

– recognize the additional stigma that boys and men may face in discussing mental health and suicide and seeking mental healthcare.

RECOMMENDATION 11

That the updated Framework recognize the impact of substance use and addiction on suicide prevention in Canada, and that funding and programming associated with suicide prevention include research and interventions into substance abuse and addiction.