Suicide Prevention Strategies: Finding Hope and Optimism
Content Warning: This blog post discusses themes of suicide. Reader discretion is advised.
Assist has four pillars of programming: professional counselling, peer support, education and awareness, and community. Our education and awareness pillar has a broad base—we share information, strategies and resources with the Alberta legal community using a variety of means, including this blog. And in order to have current and relevant content, we follow lawyer mental health, substance use, and well-being issues from credible sources.
Each week, I receive a news update from the Centre for Suicide Prevention, an Alberta-based organization committed to reducing suicide through education, which provides links to articles within the broad umbrella of suicide prevention. It is usually a sobering read, often containing tragic stories where preventive measures were unable to help or were not engaged at all. But this week, I read accounts where hope plays a large role, and I want to talk about this today. The blog is not going to have any light-hearted stories, but I hope that you will share my sense of hope that important issues relating to suicidality can be, and are being, addressed.
First, I saw a report on usage levels of Canada’s new suicide prevention three-digit telephone line, 9-8-8. This service was launched on November 1, 2023 after years of discussion, consultation and development. The 9-8-8 service has received, on average, one thousand calls and 450 texts per day. The Centre for Addiction and Mental Health, which operates the 9-8-8 service, stated that this is in the range they anticipated. CAMH also advised that about 4,500 Canadians die each year from suicide, so it is hoped that use of the service will continue to grow and that the number of deaths will decrease.
Occasionally, I receive feedback from a member of the Alberta legal community that they called Assist’s 24/7 crisis line and were shocked that the phone was picked up by an automated service. This is because Assist’s 24/7 program is not like a distress line where volunteers work round-the-clock shifts to ensure that callers are received by a warm voice—it is a service in which callers are assisted in contacting the Registered Psychologist on call, and since we do not have the budget for round-the clock staff, the automated system is the most effective way of doing so. We tell people to listen to the message and not hang up and we post written notices advising how our service works. We get about 20 after hours crisis calls per month, so you can see that at less than one per day, staffing the line with a telephone receptionist is not remotely viable.
But it seems that 9-8-8 also uses an automated call reception process. Callers can opt into French or English and are screened for relevant factors before being routed to a provider close to the caller’s location. Providers are human and local, but the call reception utilizes automated systems to get calls to the right provider. CAMH advises that responders are trained in suicide prevention and that they assess callers and provide assistance if suicide risk is identified.
Members of the Alberta legal profession, articling students and law students, as well as their dependent families, are fortunate to have Assist’s 24/7 crisis counselling option as well as 9-8-8. Occasionally, someone will ask where Assist was in the wake of a lawyer suicide and my answer is invariably the same: “I don’t know about specific situations, but all I can say is we can’t help people who don’t call us.”
Assist has a fireproof confidentiality shield between our counselling office and my office, so I do not have access to information about whether a particular individual has used or is using our counselling services. Some people do not ask for help due to stigma and fears of being judged (especially in a high-performance, competitive profession like law), and there are other resources that a person might have engaged with. But please help spread the word in your legal workplace that both Assist and 9-8-8 are available to provide support in crisis situations on an immediate and non-judgmental basis.
Secondly, I read about the need for a national suicide prevention strategy, broader than merely having a three-digit support line. Countries including Finland and Scotland which implemented a national strategy saw substantial decreases in suicide deaths (Finland saw a decrease of 9% and Scotland’s reduction was 18%.)
The World Health Organization envisions a national suicide strategy as a roadmap for reduction in risk factors for suicide as well as building resilience on both an individual and system levels, including:
- Timely access to mental health care
- Responsible and non-sensational media reporting
- Reduction of access to means of suicide, and
- Education through raising awareness, stigma reduction, gatekeeper training, research and surveillance.
To be successful, all levels and sectors of government must be involved as well as communities, and it must be part of a larger mental health strategy. Mental health strategies must be part of a larger public health strategy which provides for restrictions to lethal means (bridge barriers, blister packaging on medication, controlling firearms, for example.)
You may be wondering why I have included this article as something that inspires hope. I wasn’t feeling uplifted when I read that Canada lagged behind many of our peers, including the UK and the US. But then I read that Alberta is a leader in suicide prevention. Alberta was the first jurisdiction in the world to have a Provincial Suicidologist in 1978. Obviously, we did not eliminate suicide in the 1970s—suicide is a complex and multi-faceted phenomenon but Alberta built a four-pronged approach to prevention (known as the “Alberta Model”) consisting of coordinated community integration of outreach programs and the creation of intervention skills-training programs which led to the excellent work conducted by Alberta’s Centre for Suicide Prevention. This training program, called the ASIST program (not to be confused with our Assist program), continues to be offered by the CSP and is considered the gold standard for intervention training.
Assist signed up for the CSP’s Buddy Up Campaign in 2019-2020. Buddy Up is an example of an Alberta-created program which identifies a population with a high risk of suicidality and then develops strategies to educate and support that community. The group targeted by the Buddy Up campaign is men as men have a much higher rate of death by suicide than women. Women actually attempt suicide more often than men, so this is not to diminish risk to women, but men die by suicide at a rate three times that of women, meaning there are fewer second chances.
Assist won the Buddy Up Campaign Champion Award that year and we were able to train about twenty-five of our volunteers in a free half-day ASIST workshop. It was life-changing, and being able to make more workshops available to the legal community more broadly is on my wish list. Assist would happily fundraise to be able to provide this training to lawyers in small practices but would love to see larger firms with sufficient resources bring this training into their offices.
I don’t want to reduce a half-day training course to simplistic elements, but one aspect of the CSP’s training that is especially valuable is teaching volunteers to become comfortable with asking a person in distress if they are thinking about self-harm. We practiced these conversations through role-playing, and I can assure you that it feels incredibly awkward at first. Rather than asking this question using simple words and sentence-structure, we want to qualify our question” “I don’t mean to overstep your boundaries, and I know that you may not want to answer this question, and you sure don’t have to if you don’t want to but based on some the things you have told me, I can tell that you are very distressed and feel that I need to ask you if you are thinking about self-harm at all—not because I am passing judgment on thoughts of self harm since I am a non-judgmental person….” You get the drift. But all you need to say is “I care about you, and I’m concerned about your distress. Are you having thoughts about harming yourself.” You can then connect the person with resource specializing in suicide prevention if they say that they are currently having thoughts of suicide.
Avoidance is my go-to when things are uncomfortable, and I know that I am not alone in this space. Investing a half-day and some funds in getting comfortable with asking a question that could be uncomfortable is one of the best things you can do with your time and money.
I am optimistic and hopeful because I have seen the excellent work being done in our province. There is more work to be done, without question. We know that Indigenous populations have higher than average rates of suicide as does the LGBTQ2S+ community, and women’s risk of suicide attempts also needs education and strategies. But we have incredible resources in our province, and we can advocate for the creation of a national plan, leveraging the valuable work done right at home along with excellent programs in other jurisdictions.
And the final article this week that inspired me involves Drew Carey. Almost all of us will know Drew Carey, currently hosting the iconic tv game show, The Price Is Right. He had his own sitcom, the Drew Carey Show, for many years, but I missed that one and first saw him when he hosted Whose Line Is It Anyway, an improv comedy program. We sometimes think that being an actor, especially a comedic actor, must be fairly easy since someone else writes the gags and all they have to do is deliver them. My guess is that bad comedy might work that way, but brilliant comedy is so much more. And improv is how the true greats of comedy hone their timing and their skills.
Backing up to Drew Carey, he sounds like quite the successful guy, right? But he talks openly about his mental health struggles and two suicide attempts in his teens and twenties. He says that he learned to believe in himself and to set goals, which sounds like an easy fix but likely took considerable effort and time.
Having “successful” people share about their struggles and how they found their path forwards is inspirational for all of us (although it is important to ensure that the focus is on solutions and that it does not become performative trauma). I put “successful” in quotation marks because success is an individualistic concept, but most of us would believe that someone who has led at least three long-term TV shows meets many markers of success.
It helps for us to see that “successful” people—however you choose to define that term—were not always born lucky or had “success” fall into their laps. Many (if not most or almost all) had struggles that shook them to their cores. Rather than focusing on what their inner turmoil was, I like to look at how far they were able to travel. They rarely travelled alone, and that is usually the piece that interests me most: what kind of support did they receive? How did people let them know how much they cared?
I truly believe that we can work together to create a climate where suicidal ideation is not met with judgment or stigma. The National Study on the Psychological Health Determinants of Canadian Legal Professionals (page 41) reports that about 24% of Canadian lawyers experienced suicidal ideation since beginning their legal careers. Somehow, those lawyers were able to find the help they needed so that ending their lives was not their only option.
This is where Assist comes in, with our 24/7 crisis counselling service, matched peer support, education and awareness, and community. We want to ensure that no one in the Alberta legal community is left behind. We know that suicide prevention will take collaboration around a well-coordinated plan involving as many interested and supportive organizations and individuals as possible. We know that resources are important (from our new 9-8-8 suicide line and Assist’s 24/7 crisis response) and that trained professionals can often help distressed individuals find light and hope even when pain and darkness are pervasive.
If you are worried that someone in your midst may be experiencing suicidal ideation, you can call Assist for counselling (including through our 24/7 crisis counselling line). You don’t have to help someone by yourself. And if you are a person who is struggling with pain and darkness, please know that our non-judgmental supports are here for you. The only way we can overcome suicide in our society is through openness and collaboration. Reach out to us if you want to join the conversation.
Loraine