Ending the Darkness of Suicide

Almost 4000 Canadians die by suicide each year, and many more-perhaps 100 times as many-deliberately harm themselves (1). In 1998-1999, 22 887 hospital discharges for suicide attempts or intentional self-inflicted injury were recorded (1). More than 90% of suicide victims are known to have one or more psychiatric disorders at the time of their death, so psychiatric disorders may be considered a necessary, although not sufficient, cause of suicide (2). Despite more than 100 years of study since the time of Durkheim's seminal research, suicide continues to be a terrible tragedy that must disturb all psychiatrists. Nevertheless, today, rays of light are ending the darkness of suicide. The stigma of mental illness and suicide has been diminished by the champions among us who have stepped forward and shared their stories. Two outstanding individuals have touched me personally, and although there are several more, I must mention them specifically. More than a decade ago, Ms Doris Sommer Rotenberg courageously broke the silence enveloping death by suicide and established the Arthur Sommer Rotenberg Chair, the first academic chair in North America dedicated to suicide research. Recently, I had the great pleasure of meeting the Honourable James K Bartleman, Lieutenant Governor of Ontario. I related to him that one of my patients suffering from chronic depression and suicidality was moved to tears and felt less alienated when he read His Honour's personal story of depression in Moods magazine (3). The impact of sharing these stories cannot be measured. Other major advances must be recognized. Research is now being undertaken that targets those individuals at high risk for suicide; they must no longer be prevented from participating in clinical research. Meltzer and colleagues' groundbreaking study of clozapine for individuals with schizophrenia at high risk for suicide has established the value of such research (4). Systematic clinical trials now underway may have direct implications for clinical practice and for establishing evidence-based approaches. For example, I am involved in an effectiveness trial of dialectical behaviour therapy (5) compared with a therapy based on the American Psychiatric Association guidelines for the management of borderline personality disorder (6). This trial may provide insights into the clinical effectiveness and cost-effectiveness of systematic treatments such as dialectical behaviour therapy. Finally we, as a nation, stand poised to advance suicide prevention in each and every community. In October 2004, the Canadian Association for Suicide Prevention first publicly released the Blueprint for a Canadian National Suicide Prevention Strategy (1). Canada is one of the few developed nations without a national mental health action plan and without a national strategy for the prevention of suicide. The Blueprint provides a starting point for formulating the goals and objectives needed for a national suicide-prevention strategy. Our national strategy must promote awareness that suicide is a preventable problem and must reduce stigma toward suicide, mental illness, and substance abuse disorders. We have to foster prevention and intervention strategies, particularly strategies by Inuit, First Nations, and Metis. The Blueprint advocates reducing access to lethal means of suicide; increasing training in the recognition of risk factors, warning signs, and at-risk behaviours; promoting effective clinical practices; and improving access to, and continuity of, care. Among other objectives, we must improve and expand surveillance systems, particularly for tracking nonfatal suicidal behaviour and for promoting suicide-related research. …

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