Canadian Psychiatric Association
Association des psychiatres du Canada
Letter to the Editor
Suicide Prevention: Doing the Right Thing Is Not the Same as Doing Something
Dear Editor: We are of the opinion that suicide in Canada is a significant public health concern and a tragedy for those affected. Interventions of all types that can better prevent suicide are urgently needed, and while some (such as restriction of access to lethal means) can be applied without involving clinical inputs, most effective suicide prevention interventions are related to the early identification and effective treatment of persons with mental disorders.1 Unlike the pan-community distribution of single gatekeeping interventions that Grunau’s letter endorses, these successful interventions are multifaceted, clinically integrated programs (such as Garret Lee Smith) that include gatekeeping as only one component of many cohesive parts.2 Currently, research into gatekeeper interventions demonstrates positive impact on knowledge, attitudes, and confidence but has not established their impact as effective in suicide prevention,3 and there is evidence that applying some gatekeeper interventions may actually lead to negative outcomes. 4 Applying ineffective suicide prevention programs comes with substantial human and economic costs.5 Additional research is urgently needed to identify what works, where, and for whom. Our article makes that point clearly, and as we noted, safeTALK does not meet the evidentiary standard.6 SafeTALK is a “suicide prevention” program, sold by a private company through third-party purveyors (such as the Center for Suicide Prevention) and then to the general public and public-serving organizations; these purveyors then receive revenue for that sales activity. Sadly, safeTALK, one of these types of programs sold by the Center for Suicide Prevention, not only has no evidence for prevention of suicide, but its widening distribution also has been co-related with increased rates of suicide in young people.6 In response to that article, LivingWorks wrote a self-serving response, noteworthy for its obfuscation of the evidence for suicide prevention and inaccuracies regarding recent suicide rate trends in young people. LivingWorks then requested that the Center for Suicide Prevention publicize its corporate statement. This highly misleading missive was duly posted by the Center for Suicide Prevention (https://www.suicideinfo.ca/respondingcritique-safetalk/).
The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie 2017, Vol. 62(4) 296-297 ª The Author(s) 2017 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0706743717695087 TheCJP.ca | LaRCP.ca
To our minds, this raises a serious issue of conflict of interest in organizations that have a public responsibility for transparent and ethical practice. LivingWorks does not have that responsibility, and selling its products to make money is its prime purpose. As in the field of nutritional supplements and homeopathy, it is buyer beware. The Center for Suicide Prevention, which sells the safeTALK training program, however, does have that responsibility. As a respected national spokesperson for mental health, and in the absence of regulatory oversight of psychosocial mental health– related programs, the Center for Suicide Prevention should be taking a leadership role in ensuring that the programs it sells are evidence based, effective, and safe. This means that when the Center for Suicide Prevention endorses or sells a suicide prevention program, there should be robust evidence that the program prevents suicide. This responsibility cannot be discharged by citation of a Malcolm Gladwell story and website posting of LivingWorks marketing materials. Stan Kutcher, MD Dalhousie University, Halifax, Nova Scotia [email protected] Yifeng Wei, Med Pegah Behzadi, MD IWK Health Centre, Halifax, Nova Scotia Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Zalsman G, Hawton K, Wasserman D, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet. 2016; 3(7):646-659. 2. Godoy Garraza L, Walrath C, Goldston DB, et al. Effect of the Garrett Lee Smith memorial suicide prevention program on suicide attempts among youths. JAMA Psychiatry. 2015;72(11): 1143-1149.
La Revue Canadienne de Psychiatrie 62(4)
3. Isaac C, Elias B, Katz LY, et al. Gatekeeper training as a preventative intervention for suicide: a systematic review. Can J Psychiatry. 2009;54(4):260-268. 4. Sareen J, Isaak C, Bolton SL, et al. Gatekeeper training for suicide prevention in First Nations community members: a randomized control trial. Depress Anxiety. 2013;30(10):1021-1029.
297
5. McLennan JD. Persisting without evidence is a problem: suicide prevention and other well-intentioned interventions. J Can Acad Child Adolesc Psychiatry. 2015;24(2):131-132. 6. Kutcher S, Wei Y, Behzadi P. School- and community-based youth suicide prevention interventions: hot idea, hot air, or sham? Can J Psychiatry. 2016 Jul 12 (Epub ahead of print).
Association des psychiatres du Canada
Letter to the Editor
Suicide Prevention: Doing the Right Thing Is Not the Same as Doing Something
Dear Editor: We are of the opinion that suicide in Canada is a significant public health concern and a tragedy for those affected. Interventions of all types that can better prevent suicide are urgently needed, and while some (such as restriction of access to lethal means) can be applied without involving clinical inputs, most effective suicide prevention interventions are related to the early identification and effective treatment of persons with mental disorders.1 Unlike the pan-community distribution of single gatekeeping interventions that Grunau’s letter endorses, these successful interventions are multifaceted, clinically integrated programs (such as Garret Lee Smith) that include gatekeeping as only one component of many cohesive parts.2 Currently, research into gatekeeper interventions demonstrates positive impact on knowledge, attitudes, and confidence but has not established their impact as effective in suicide prevention,3 and there is evidence that applying some gatekeeper interventions may actually lead to negative outcomes. 4 Applying ineffective suicide prevention programs comes with substantial human and economic costs.5 Additional research is urgently needed to identify what works, where, and for whom. Our article makes that point clearly, and as we noted, safeTALK does not meet the evidentiary standard.6 SafeTALK is a “suicide prevention” program, sold by a private company through third-party purveyors (such as the Center for Suicide Prevention) and then to the general public and public-serving organizations; these purveyors then receive revenue for that sales activity. Sadly, safeTALK, one of these types of programs sold by the Center for Suicide Prevention, not only has no evidence for prevention of suicide, but its widening distribution also has been co-related with increased rates of suicide in young people.6 In response to that article, LivingWorks wrote a self-serving response, noteworthy for its obfuscation of the evidence for suicide prevention and inaccuracies regarding recent suicide rate trends in young people. LivingWorks then requested that the Center for Suicide Prevention publicize its corporate statement. This highly misleading missive was duly posted by the Center for Suicide Prevention (https://www.suicideinfo.ca/respondingcritique-safetalk/).
The Canadian Journal of Psychiatry / La Revue Canadienne de Psychiatrie 2017, Vol. 62(4) 296-297 ª The Author(s) 2017 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0706743717695087 TheCJP.ca | LaRCP.ca
To our minds, this raises a serious issue of conflict of interest in organizations that have a public responsibility for transparent and ethical practice. LivingWorks does not have that responsibility, and selling its products to make money is its prime purpose. As in the field of nutritional supplements and homeopathy, it is buyer beware. The Center for Suicide Prevention, which sells the safeTALK training program, however, does have that responsibility. As a respected national spokesperson for mental health, and in the absence of regulatory oversight of psychosocial mental health– related programs, the Center for Suicide Prevention should be taking a leadership role in ensuring that the programs it sells are evidence based, effective, and safe. This means that when the Center for Suicide Prevention endorses or sells a suicide prevention program, there should be robust evidence that the program prevents suicide. This responsibility cannot be discharged by citation of a Malcolm Gladwell story and website posting of LivingWorks marketing materials. Stan Kutcher, MD Dalhousie University, Halifax, Nova Scotia [email protected] Yifeng Wei, Med Pegah Behzadi, MD IWK Health Centre, Halifax, Nova Scotia Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship, and/or publication of this article.
References 1. Zalsman G, Hawton K, Wasserman D, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet. 2016; 3(7):646-659. 2. Godoy Garraza L, Walrath C, Goldston DB, et al. Effect of the Garrett Lee Smith memorial suicide prevention program on suicide attempts among youths. JAMA Psychiatry. 2015;72(11): 1143-1149.
La Revue Canadienne de Psychiatrie 62(4)
3. Isaac C, Elias B, Katz LY, et al. Gatekeeper training as a preventative intervention for suicide: a systematic review. Can J Psychiatry. 2009;54(4):260-268. 4. Sareen J, Isaak C, Bolton SL, et al. Gatekeeper training for suicide prevention in First Nations community members: a randomized control trial. Depress Anxiety. 2013;30(10):1021-1029.
297
5. McLennan JD. Persisting without evidence is a problem: suicide prevention and other well-intentioned interventions. J Can Acad Child Adolesc Psychiatry. 2015;24(2):131-132. 6. Kutcher S, Wei Y, Behzadi P. School- and community-based youth suicide prevention interventions: hot idea, hot air, or sham? Can J Psychiatry. 2016 Jul 12 (Epub ahead of print).
