Suicide Among Aboriginal People in Canada - Institut universitaire ...

Chapter 5Although they may visit a physician in the weeks or months prior to the event, most people who dieby suicide do not openly discuss their intention during medical visits (Isometsa et al., 1995). Thus, itrequires skill and expertise to establish rapport and detect the signs of depression and despair (AmericanPsychiatric Association, 2003). However, many primary care clinicians are not adequately trained and donot feel competent to diagnose and treat suicidal behaviour.A number of studies have found that where clinicians have received education in suicide recognition,intervention, and prevention the rates of suicide and attempted suicide had been reduced (Gould,2003). There is evidence that a one-day training program can significantly improve the ability of generalpractitioners to recognize psychological distress and suicidal ideation among youth, but is not sufficientto modify their management (Pfaff, Acres, and McKelvey, 2001). Practice audits that review physicianperformance according to established guidelines may prolong the effect, and having appropriate trainingin interventions and support staff would promote effective treatment. In some studies, most peoplewho died by suicide were not taking antidepressants, suggesting they had not been adequately treated(Henriksson, Boethius, and Isacsson, 2001).It is sometimes suggested that people who have suffered through similar predicaments and survived havethe knowledge they need to help others. While such experiences may bring wisdom, compassion, andunderstanding they do not necessarily make someone competent to help suicidal individuals. Indeed, thereis some evidence that their own past suicide attempt can impair even trained counsellors’ ability to respondeffectively to their clients (Neimeyer, Fortner, and Melby, 2001). Clearly, there is a need for effective training,supervision, and support of helpers in clinical settings as well as in crisis hotlines or other sources of help.In remote communities, arranging contact with mental health professionals may be difficult. Maintaininglong-term contact with previously hospitalized patients may be extremely helpful (Motto and Bostrom,2001). The simple effort to contact someone after the acute crisis or hospitalization is over may send apowerful message of caring and concern. The typical pattern of sending people out of remote communitiesfor time-limited treatment may lead to discontinuities in care that put people with chronic problems atgreater risk. Strategies for maintaining long-term (even if infrequent) contact must be developed.Tertiary Prevention or PostventionAftercare services provide help for those who have made a suicide attempt or have shown other tendenciesfor self-injury as such individuals are at high risk for completing suicide at a later time. The forms ofsupport should include both appropriate clinical services to treat psychiatric illness and non-medicalapproaches to mental health and healing (examples include peer counselling, close supervision, family andsocial network intervention, and counselling by Elders). Services need to be accessible and meaningfulto persons who “may be in conflict with the criminal justice system, have issues with substance use orsexuality, or be otherwise alienated from helping services” (Commonwealth Department of Health andFamily Services, 1997:34 th pg., 8 th para.). Support also needs to be in place for family and communitymembers affected by a suicide attempt or death.Suicide has significant impact on family and friends of the victim—increasing depression for at leastsix months after the event. Many authorities advocate the provision of counselling aimed at promotingnormal mourning and avoiding pathological grief responses (Kirmayer et al., 1993b). In order to respondin a timely fashion to a suicide, it is important to have essential services and a coordinating team in place.95