A new way to rescue SUICIDES

More than 3,000 Canadians take their own lives each year, yet only the Salvation Army is organized to fight the problem. But new prevention centres in Europe and the U.S., with 24-hour stand-by teams of specialists ready to help, offer a pattern for action here. Here’s how they work

BEN ROSE October 2 1965

A new way to rescue SUICIDES

More than 3,000 Canadians take their own lives each year, yet only the Salvation Army is organized to fight the problem. But new prevention centres in Europe and the U.S., with 24-hour stand-by teams of specialists ready to help, offer a pattern for action here. Here’s how they work

BEN ROSE October 2 1965

A new way to rescue SUICIDES

More than 3,000 Canadians take their own lives each year, yet only the Salvation Army is organized to fight the problem. But new prevention centres in Europe and the U.S., with 24-hour stand-by teams of specialists ready to help, offer a pattern for action here. Here’s how they work

BEN ROSE

EVERY DAY ABOUT ninety people in Canada attempt to take their own lives and nine succeed, resulting in more than three thousand deaths a year by suicide. The tragic feature of this toll is that suicideprevention centres, such as exist in the United States and Europe, and new knowledge gained from research, could prevent at least two of every three of these deaths, saving the lives of two thousand Canadians a year.

This is a lifesaving mission in which most Canadians can play a part. The most effective prevention efforts depend on early detection of suicidal clues by a relative, neighbor, friend, or stranger. The experience in countries where suicide-prevention clinics have been established for some time has proven that cries for help of this kind can be heard — and answered — by average citizens.

Most of the suicide-prevention centres have twenty-four-hour telephone service, which is often the lifeline to survival for potential suicides. One of the best-organized and best-financed of these agencies is in Los Angeles (the U.S. government has spent a million and a half dollars on its operation since 1958). The directors of this centre recently stated, “Nearly every case of suicide can be prevented.” Harry Warren, Jr., director of the Save-A-Life League in New York, the oldest suicide-prevention agency in the U.S., agrees. The league has handled fifty thousand cases in fifty years of existence.

Suicide is described as one of Canada’s most neglected publichealth problems by Dr. J. D. Griffin, of Toronto, general director of the Canadian Mental Health Association. There are, at the present time, no agencies in Canada similar to that in Los Angeles, which is manned by a staff of professionals, including psychiatrists, psychologists, and social workers. Some help is available, however. The Salvation Army operates a network of thirty-four antisuicide bureaus in Canadian cities, towns and villages, all with twenty-four-hour telephone service, and manned by senior Army officers. They offer sympathetic counsel, resort to the Army’s many welfare services, and to medical and hospital help when necessary.

Modern antisuicide measures result from the studies of motives, personality and environmental factors in thousands of cases of suicide and attempted suicide in the files of suicide-prevention centres in the United States. Briefly, they include more efficient methods of spotting a potential suicide before he makes the fatal move; weeding out the highest-risk cases for intensive treatment and follow-up; and bringing the person who needs help quickly to the people and places that can give it.

These measures save lives because eight out of ten people who kill themselves give clear advance warning of their intent to someone. This is contrary to the widely held — and mistaken — notion that people who talk about committing suicide never do anything about it. S-p centres depend on making the first contact with the potential victim by telephone and holding that contact, no matter how tenuous, while preventive measures are launched. “The patient’s life may depend upon the handling of the first call.” says Dr. Robert E. Litman, director of the Los Angeles agency.

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When the phone rings, it’s a call for help and a life hangs in the balance

SUICIDES

The first aim of the people manning these “hot” lines is to get a name, a telephone number, and, if possible, an address before the call is interrupted.

The call itself reveals an important fact about the person at the other end of the line: he is not sure whether he wants to die, or, to put it more positively, he has a latent wish to live, or he would not have made the call. The s-p staffs in such places as Los Angeles and San Francisco use the word “help” as often as they can, and as early as they can, in that vital first call. They listen to the caller’s story, incoherent and rambling as it may be, their own interjections carrying sympathy and warmth, and no criticism — a click at the other end might follow a mechanical, uninterested or disbelieving comment.

Since the callers are looking for a plan of action, the interviewers try to get an agreement from them to do something definite — to come to the office at an appointed time the next day, to accept a phone call at a certain time later that day or the following day, or to visit a doctor, a relative or a friend. Nothing is left to chance in keeping the connection alive. A psychiatric follow-up of the degree of risk reported by the Los Angeles interviewers in telephone appraisals of one hundred cases showed that they did not miss one serious case.

One factor of great significance turned up by s-p research is that people are acutely suicidal for only a short time — comparable to the “crisis” of fever-racked patients — and if they can be helped through this crisis they will survive in nearly every case.

It is not true that once a person attempts suicide he will always continue to be a suicidal risk, but an eight-year follow-up of one hundredand ninety-three patients by the Golden Gate Clinic in San Francisco revealed that nearly one in three did make another attempt, and some succeeded.

On the basis of these records, the clinic devised a “high-risk” test to identify incoming patients who need the most care and follow-up. Dr. Earl Cohen, the clinic’s director, says this procedure will save additional lives.

This study also confirmed findings applicable to the general population — that the four highest risk groups are elderly men, either very rich or very poor, people suffering from depression, widowed, separated or divorced persons, and those with records of previous attempts.

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The suicide rate in West Berlin, possibly related to political tensions, is the highest in the world (thirtythree per one hundred thousand of population), compared to 7.6 in Canada (1963) and ten in the United States.

Dr. Klaus Thomas, a Lutheran minister and psychiatrist, former director of the Suicide Help Centre in West Berlin, recently reported to the annual meeting of the American Psychiatric Association in New York on efforts to reduce this appalling toll. Sixty percent of West Berlin’s suicides, Dr. Thomas said, were the result of problems connected with sex, love and marriage. Before the agency started in 1955 there was an average of a hundred attempts at suicide on Christmas Eve — one in three successful. When the centre first opened, people waited in line for hours to get in, and during the next six years lonely and friendless people were entertained at Christmas Eve dinners sponsored by the centre, with the result that the average number of suicide attempts in the city on that evening was reduced to ten, with only three deaths.

The suicide-prevention centre in Vienna (Lehe ns mild en für sorge) sponsored by Caritas, a Roman Catholic welfare body, helped to reduce suicides to less than a quarter of the previous number. The centre is directed by a noted psychiatrist, Dr. Erwin Ringel.

In Britain, where there are thirty times more suicides than murders in an average year, the best-known prevention organization is that of the Samaritans, founded by an Anglican minister, the Reverend Chad Varah, in 1953. It has thirty-nine branches in England and Scotland. They assign a member of the Company of Samaritans as a friend for the "client.” “A Samaritan, having no professional skill to offer,” says Varah, “can only offer himself, and this is what most of the clients want more than anything else.”

In the U. S., other s-p centres with twenty-four-hour telephone services include Rescue, Inc., in Boston, founded by the Reverend Kenneth Murphy, of St. Francis de Sales Roman Catholic Church, and FRIENDS, in Miami, an agency operated by volunteers. New agencies have just opened in Chicago and Philadelphia.

The Miami clinic is reached by a number that spells its name — FRIENDS — on the dial. A Miami housewife whose number was very similar to this was plagued by calls, at all hours, asking for the antisuicide service. Her rejoinder was always, “Drop dead!”

One man complained to the same centre, when he finally got through, that he had been dialing the number for nights without getting an answer. It turned out that he had been guilty of either misspelling or misjudging the FRIENDS. He had been dialing “FIENDS.”

"You need a sense of humor in this work,” observes Los Angeles’ Dr. Robert Litman.

The stimulus to establish suicideprevention centres in all areas has often come from the church. In Canada, the Venerable T. P. Crosthwait, Archdeacon of York and rector of St. Clement’s Church in Toronto, is the moving force behind an effort in this direction. He and his ministers and parish workers decided they needed more information about community resources to assist their troubled parishoners. They also wanted professional advice on the recognition of suicide danger signals. As a result, St. Clement’s Church will co-sponsor, along with the Toronto branch of the Canadian Mental Health Association, a seminar and conference in Toronto in November to be led by the associate chief psychiatrist of the Los Angeles centre. The conference will unofficially explore the feasibility of a centre of that type in Toronto.

One of the U. S. studies discloses that most of the suicide victims in one year had visited a doctor ( not a psychiatrist) sometime in the previous five months, but the doctors had failed to recognize signs of suicidal intentions. This is why it is considered so important to offer training courses to family doctors in Canada. Some general practitioners, evidently, still feel they are not able to treat patients with mental illness.

Dr. David Lander, of Black Diamond, Alta., pokes a little fun at this attitude in the following poem:

Lord all 1 ask is sense to flee From folk who need psychotherapy; Let somatic ills keep me employed In general practice un-a-Freud.

Dr. Julien Bigras, a psychiatrist at Ste-Justine hospital in Montreal, says adolescent suicides are increasing and that the problem is being ignored by both the public and government. "This is because there is so much anxietyattached to suicide." says Dr. Bigras. "It is a symbol of failure, and people won't face up to it."

Dr. Yvon Gauthier, another psychiatrist at Ste-Justine. says signals by disturbed girls for help were not recognized by pediatricians, family doctors and members ol the family: if they had been, twenty-two girls he knew of might not have attempted suicide. Dr. Gauthier says a twentyfour-hour antisuicide telephone service might have been used by these girls to get help.

Dr. Clarence Jones, of Halifax, a psychiatrist who is president of the Canadian Medical Association, says suicide-prevention efforts can be integrated effectively with a community's mental-health program if a round-theclock emergency service is available in one of the general hospitals with a psychiatric unit, as it is in the Victoria General Hospital in Halifax. In larger cities, he says, an antisuicide clinic operating in quarters of its own. and under its own name, might do a better job by attracting a zealous and research-minded staff, while providing a sharper focus for public education and support.

Dr. Earl Cohen, director of the San Francisco clinic, criticizes his fellowpsychiatrists for their failure to shake themselves free of the social taboos that prevent a free and open discussion of suicide. (The government-supported program of psychiatric research in Canada does not include any study directly related to suicide or its prevention.)

In 1962. its first complete year of operation, the Salvation Army’s antisuicide bureaus in Canada received four hundred and eight calls serious enough to require some kind of action. Fast year the number of cases increased to more than eleven hundred. In the first six months of 1965. nine hundred cases were handled.

The Clarke Institute, a new psychiatric hospital and teaching centre in Toronto, is to initiate a mobile consultation service early in 1966 capable of giving first aid at the scene of suicide attempts or other psychiatric emergencies. The institute hopes to co-ordinate this service with emergency facilities of other psychiatric and general hospitals.

Sixty-four-year-old Ft.-Col. Oliver CF Welbourn, director of the Salvation Army's antisuicide service, is a veteran of forty years service with the Army. His blue eyes glint kindly behind square-rimmed glasses, and he combines the ability to listen with the ability to talk earnestly, persuasively and so rapidly that there remains no awkward pause during which a man pondering suicide might hang up. It would surprise anyone passing this short, bald, almost pi.xielike figure on the street to know that his days, and many nights too. are spent convincing people that life is worth living.

In 1963. according to official Dominion Bureau of Statistics figures, a total ol 1.436 Canadians committed suicide, compared to 1.331 the year before and 1.287 in 1959. The rate per hundred thousand of population increased from 6.1 in 1944 to 7.6 in 1963. but it was above this mark during the depression of the 1930s.

Doctors, lawyers and police agree that the official suicide figures compiled by DBS from police records represent less than half the actual number. The highest rates of suicides in 1963 were on one coast, the Yukon ( 13.3 per 100.000) and BC ( 13). and the lowest on the other coast. New'foundland (3.3). The other rates were: Saskatchewan 9.8. Ontario 8.9. Manitoba 8.5. Alberta 7.6. Nova Scotia 6.1. PEI 5.6. Quebec 4.8. New Brunswick 4.7 and Northwest Territories 4.2.

Most Canadians respond magnificently to a cry for help when it comes in a dramatic form or in a way approved by society. Hundreds voluntarily join search parties for a little girl lost in the bush. Most of us can also answer a different, though just as urgent, cry for help. What are the clues to watch for? They include repeated suicidal threats and talk of death by people who have been ill or unhappy for some time; also such acts as making a will, discussing insurance policies, putting affairs in order —if these acts are accompanied by suicidal talk or general unhappiness.

The good which nonprofessionals can do by their counsel is considerable. according to Dr. Fitman. A study is under way at Dalhousie University. in Halifax, to find out if the talents of volunteers can be used in manning community mental - health services.