2014-11-17 Decisions - Board of Health

The Board of Health recommends that:

1. City Council direct and provide funding to the Toronto Transit Commission to implement the following actions, to improve passenger safety including suicide prevention:

a. All future extensions or new lines include Platform Edge Doors or other means for restricting unauthorized access to the subway tracks by members of the public in the design of stations; and

b. Retrofit existing stations with Platform Edge Doors or other means for restricting unauthorized access to the subway tracks by members of the public to realize significant benefits from the completion of the automatic train control upgrade to the signal system.

2. City Council direct the Chief of Toronto Police Services, Chief/General Manager of Fire Services, and Chief of Toronto Paramedic Services, in consultation with the Medical Officer of Health, to implement and enhance services and supports to prevent suicide among first responders, including but not limited to building awareness and reducing stigma of mental illness and help-seeking for Post-Traumatic Stress Disorder.

3. City Council direct the City Manager, in collaboration with the Medical Officer of Health, to develop a multi-component Suicide Prevention Plan for Municipal Services.

The Board of Health:

1. Requested the Medical Officer of Health, in collaboration with a major Toronto media outlet, to hold a forum for journalists on best practices in media reporting on suicide.

2. Requested the Medical Officer of Health to develop and implement a public awareness campaign that focuses on reducing stigma related to risk factors of suicide and increasing knowledge about resources available for support and intervention. The campaign should include collaboration with health care experts, community agencies and other stakeholders.

3. Requested the five Toronto Local Health Integration Networks (LHINs) responsible for Toronto, in collaboration with health care regulatory and professional associations, to fund and mandate evidence-based and culturally competent gatekeeper training for health providers who work with at-risk and high risk individuals for suicide in Toronto.

4. Requested the Chief Coroner for Ontario to implement the following actions:

a. Provide more timely and accessible information regarding suicide deaths in Toronto, including systematic collection of a broader range of socio-demographic indicators (e.g. income, race, ethnicity, language, sexual orientation, occupation) to identify populations at risk for suicide; and

b. Explore a multidisciplinary approach to suicide death investigations in Toronto, in collaboration with public health professionals, to identify further opportunities for suicide prevention.

5. Requested Health Canada and the National Association of Pharmacy Regulatory Authorities to restrict the availability of over-the-counter drugs commonly used in overdose, such as requiring blister packaging and placing specific drugs behind the pharmacy counter.

6. Requested Accreditation Canada to enhance suicide prevention standards and practice guidelines for healthcare institutions providing mental health services to include the following:

a. Ensure design and operating policies reduce or eliminate access to lethal means and ensure appropriate staffing levels and training to prevent suicide attempts; and

b. Ensure that suicide prevention resources and services are provided, particularly in the post-discharge period, for specific populations known to be at very high risk for suicide, including people diagnosed with mental disorders.

7. Requested the Canadian Institutes of Health Research, Knowledge Translation Branch to fund research to address gaps in knowledge related to suicide, including, means restriction and other effective preventative interventions for suicide by hanging, the role and impact of the Internet on suicide-related behaviour, and effective interventions.

8. Forwarded the report (October 30, 2014) from the Medical Officer of Health to the four Toronto School Boards and Toronto's universities and colleges to encourage them to build on existing efforts to prevent and reduce risk for suicide and promote mental health among children, youth and young adults.

9. Forwarded the report (October 30, 2014) from the Medical Officer of Health to the Chief Public Health Officer of Canada, the Chief Medical Officer of Health of Ontario, Ontario Minister of Children and Youth Services, Mental Health Commission of Canada, Canadian Mental Health Association, Canadian Association for Suicide Prevention, College of Physicians and Surgeons of Ontario, College of Nurses of Ontario, Ontario Medical Association and the Registered Nurses Association of Ontario.

The Medical Officer of Health gave a presentation to the Board of Health.

Suicide resulted in 243 deaths in Toronto in 2009, which is more than four times the number of people who died from homicide, and three times the number who died from motor vehicle crashes. Suicide is the tip of the iceberg in a continuum of suicide-related behaviours, including self-harm, suicidal ideation and suicide attempts, which contribute to the burden of suicide. Suicide not only results in loss of life but also impacts survivors, family, friends and observers. Yet, despite agreement that suicide is a problem in society, it has received comparably low levels of attention as a public health issue. Suicide remains one of the most important and least talked about population health issues.

This report reviews available evidence on suicide in Toronto, including a review of published evidence, analysis of administrative and Coroner's data on deaths by suicide in Toronto, a jurisdictional review of suicide prevention strategies from across Canada and worldwide, a scan of federal and Ontario suicide prevention policies, and identified gaps and opportunities for suicide prevention initiatives in Toronto. A panel of external advisors, including researchers, clinicians and community experts, provided strategic and directional advice and helped to identify areas for action, key recommendations and gaps in knowledge.

Based on this review this report provides recommendations for suicide prevention in Toronto. There is strong evidence that restricting access to the most common means of suicide death, such as subway tracks and certain medications, is effective in preventing suicides. Other effective suicide prevention interventions include media reporting guidelines, public awareness and education, gatekeeper training, and community and school-based prevention programs. Many efforts need to be part of the solution; no one intervention will be effective on its own to reduce the overall burden of suicide in Toronto.

Help is Available

If you or someone you know may be experiencing signs of suicide risk, seek help as soon as possible. There is always help available. You are not alone.

Crisis Lines (24/7)

Toronto Distress Centre: 416-408-HELP (4357)

Gerstein Centre: 416-929-5200

If you are in crisis and require emergency assistance, please go to the nearest hospital or

call 911.