Hon. Stan Kutcher, pursuant to notice of November 24, 2021, moved:

That the Standing Senate Committee on Social Affairs, Science and Technology be authorized, when and if it is formed, to examine and report on the Federal Framework for Suicide Prevention, including, but not limited to:

(a)evaluating the effectiveness of the Framework in significantly, substantially and sustainably decreasing rates of suicide since it was enacted;

(b)examining the rates of suicide in Canada as a whole and in unique populations, such as Indigenous, racialized and youth communities;

(c)reporting on the amount of federal funding provided to all suicide prevention programs or initiatives for the period 2000-2020 and determining what evidence-based criteria for suicide prevention was used in each selection;

(d)determining for each of the programs or interventions funded in paragraph (c), whether there was a demonstrated significant, substantive and sustained decrease in suicide rates in the population(s) targeted; and

(e)providing recommendations to ensure that Canada’s Federal Framework for Suicide Prevention and federal funding for suicide prevention activities are based on best available evidence of impact on suicide rate reduction; and

That the committee submit its final report on this study to the Senate no later than December 16, 2022.

He said: Honourable senators, today I rise to speak about the importance of preventing suicide and to expand upon why I am bringing this motion forward for the study of the Federal Framework for Suicide Prevention by the Standing Senate Committee on Social Affairs, Science and Technology. Suicide is an issue that we are all aware of, and a tragedy that has touched many of us in this chamber.

I ask that you consider voting in favour of this when it comes forward. Let me explain why I feel this study is timely and greatly needed.

Prior to my arrival at the Senate, I spent my professional career trying to help improve the lives of young people and families touched by mental illness. This has included doing all I could to assist them during some of their darkest moments, such as when they were convinced that their lives were not worth living and that they would be better off dead.

I have sat with families who lost a loved one to suicide — usually unexpected and mostly unexplained. In their grief and their sorrow, they often blamed themselves and wondered why. Rarely could this question be answered.

I have also sat with colleagues as they struggled with the sudden death of one of their patients and questioned the care they had provided and whether they had the skills to be a clinician.

I have also studied suicide from many angles, mostly in young people, and taught psychiatrists and physicians how to support, assess and manage patients at risk of suicide — indeed, I have written a textbook on this.

Beyond this professional experience, I have, like others in this place, been deeply wounded by the sudden and unexpected death of a beloved family member. It was my uncle, a highly successful banker with a loving and caring family. Nobody picked up on his depression. He sought medical attention, but his physician focused on his sleep difficulties and fatigue. He sought solace from his pastor who attributed his anguish to a loss of faith. At work, his performance deteriorated but, because he was in charge, nobody spoke up.

He — as was his wont for always tying up loose ends — prepared his will, organized his affairs and made sure that every family member would not have financial difficulties after he was gone. All this we learned after the fact.

For me, although I had not seen or spoken to him for many months prior to his death — he lived in Vancouver and I in Toronto — I blamed myself, that as someone who has taught others about suicide prevention, I had failed miserably in regard to my own family. Not only had I failed him, but I had failed all of us.

So I have a personal as well as a professional interest in helping develop and deploy suicide prevention interventions that can demonstrate, when they are applied, that the rates of suicide decrease and stay that way.

In turn, I have no time for those who use the anguish of suicide and the pain and suffering of others to sell, promote or initiate activities, programs or products that they claim will prevent suicide but do not.

I do not expect every specific suicide prevention intervention will stop all suicides from happening. But I do expect that if someone is telling Canadians that the intervention they are promoting prevents suicide, that there is robust and solid best-available evidence, independently determined and published in peer-reviewed journals, that demonstrates that the specified intervention actually does prevent many suicides.

What we want to do is apply interventions that we know prevent suicide. What we do not want to do is apply interventions that, appealing as they may be, have marginal or no clearly demonstrated impact on preventing suicide.

Canada’s national suicide prevention framework unveiled in 2012, following the passage of Bill C-300, an Act respecting a Federal Framework for Suicide Prevention, is supposed to do that. The question is, does it? What impact has it had on suicide rates in Canada and in specific populations within Canada since its inception? We need to know.

Suicide is an emotional topic, thus when we address suicide prevention, we must be certain to use our sober second thought to ensure that, in our wish to find something that works, we don’t end up supporting, promoting and funding those things that do not. In short, doing something is not the same as doing the right thing.

Robust scientific study, using appropriate design methods and analytics, is needed to measure rates of suicide reduction. Through a committee study, I propose we examine all aspects of the framework’s guidance on what should be done and determine the effectiveness of each individual component. Then Canadians can have comfort that what is needed to be done to prevent suicide is indeed being done, and we are not spending valuable resources on what sounds good but may not be helpful in decreasing suicide rates and not investing at the margins but where our returns will be the greatest.

A study could additionally look at other measures that would at least demonstrate important secondary benefits of suicide prevention. Some reassurance could come from knowing if what we saw were significant and substantive decreases in visits to emergency rooms and hospitalizations for suicide attempts. At the same time, we need to demonstrate what else needs to be done to show that suicides are, indeed, being prevented.

We would like to be assured that the interventions that are being put into place have robust and solid evidence that they worked prior to them being applied. Not to do so is the same as taking a treatment for a potentially fatal condition that had never been scientifically studied and demonstrated to be effective.

We would not condone spending large amounts of taxpayers’ money for interventions that had little or no evidence of effectiveness.

Canadians need to know that the framework provides the best directions possible for achieving significant, substantive and sustainable decreases in rates, and that it does not promote a myriad of activities that may seem at first glance to be effective suicide prevention interventions but, on close critical examination, are shown not to be so.

We know that suicide rates are not equally distributed across Canada. Rates are considerably higher in Indigenous populations compared to the national average, especially in young people. The need for effective suicide prevention programs in these communities is essential. Year after year, we are reminded that this need has not been addressed. Year after year, we hear calls for the creation and deployment of effective suicide prevention programs, especially for young people.

Has the framework made a significant and substantial difference in addressing this pressing need? We need to know.

Prior to and following the creation of the framework, considerable amounts of money have been spent by various federal ministries in pursuit of suicide prevention. However, to my knowledge, it is not usually known what impact this spending has made on significantly and substantively reducing suicide rates. For example, a paper published recently in BMC Public Health in 2018 described this concern. It noted that between 2005-06 and 2015-16. The federal government had spent $108 million on a national Aboriginal youth suicide prevention strategy, but an evaluation of the impact of this program noted that “. . . there was no clear picture of whether or not the NAYSPS had an impact, positive or negative, on suicide rates.”

We do not know if the framework demands rigorous, independent evaluation of all federal government investment in suicide prevention, and we need to know that.

A plethora of training programs and other interventions purporting to prevent suicide have been nationally marketed and rolled out by the private sector and civil society organizations over the past decade. With these, a number of questions have arisen. What relationship, if any, should the framework have with these initiatives? What independent, robust evidence is there that any of these products actually prevent suicide? Should taxpayer funds be used to purchase and support these programs? Does the framework now appropriately engage with these issues and provide appropriate guidance? These are all important questions that the committee studied and addressed.

As parliamentarians, we need to ensure that the framework is built on the best available evidence that has identified what works and what does not. There is good information to guide the design of a committee study. For example, there have been a number of helpful reviews of suicide prevention interventions, and these have identified some interventions that have reasonable evidence that they may actually prevent suicide and some for which evidence is lacking. Has the framework used this evidence in its development and application? We need to know.

If we want to make an impact on suicide prevention, we need to look at those populations where the rates are greatest. I have already raised the sad reality of excessively high suicide rates in Indigenous communities, but there are other groups on which we must also focus. While Canada’s suicide rates range from 10 to 12 per 100,000 in people who live with a mental illness like schizophrenia, the lifetime rate is about 5%. For the math, this translates into 5,000 per 100,000, not 10 or 12 per 100,000.

There are about 360,000 Canadians living with schizophrenia right now. For comparison, that equals more people with schizophrenia dying of suicide than the total number of Canadians who died from suicide in 2014 to 2018 inclusive. For those living with a bipolar disorder, the rates of suicide are estimated to be between 10 and 30 times higher than the general population. Individuals who live with a substance-use disorder are also more likely to die by suicide, and this increase is even greater in women than in men. We need to know if the framework does enough to address the needs of these high-risk populations.

Senators, I have laid out some of the issues that a committee study examining the substance of the framework and its impact over the last decade can tell us. Such a study can also recommend what adjustments may be needed to the framework to guide suicide prevention in Canada over the next decade and longer.

Honourable senators, Canada’s national suicide prevention framework should be able to demonstrate a positive impact on significantly and substantively decreasing rates of suicide in the general population and particularly in those unique populations where the rates are the highest. To achieve this goal, it must identify and drive the application of interventions that, based on best available scientific evidence, are known to be effective. It must invest in what works to actually prevent suicide, not in what some hope might work or in interventions with marginal impact on the primary outcome. And it must protect Canadians from opportunistic promotion and sale of so-called suicide prevention interventions if there is insufficient evidence for their effectiveness.

Colleagues, we have a golden opportunity to conduct a constructively critical and comprehensive study of this important issue. In their election platforms, the Liberal Party, the Conservative Party and the NDP all identified mental health as an area of action. A new Ministry of Mental Health and Addictions has just been established, a first in the history of the Canadian federal government. The time is right for us to move quickly.

I realize that committees are masters of their own fate and will decide what they deem necessary to study and when. That said, our committees can be informed by what this chamber considers to be priority areas. Social Affairs is the ideal committee in which to undertake this work.

Thank you for your consideration. I hope when the time comes, you see it proper to vote in support of this motion. Thank you. Welalioq.