These slides are available for use with this section of the presentation. For information about downloading presentation slides, see Introduction.
For the cover of this guide and for many of the slides, this guide uses images of trees and forests. Trees sustain life on earth and are a powerful symbol of growth, interconnection, resilience, and strength. The red cedar is a particularly important tree to many Indigenous Peoples on the west coast of British Columbia. Below is one perspective on the importance of the red cedar tree to Kwakwa̱ka̱’wakw people.
In the Kwakwa̱ka̱’wakw Nation, the red cedar is known as our tree of life. This tree expresses our responsibility as stewards of the land. The roots of a red cedar tree go deep, and when they are connected to other trees, they can share natural resources to support the health of the forest communally. Ever since the Kwakwa̱ka̱’wakw people came into existence thousands of years ago, from our birth to the ceremony mourning our passing as individuals, the tree of life has played – and continues to play – a crucial role in every aspect of our lives.
Kwakwa̱ka̱’wakw people have sacred teachings on sustainably harvesting the bark of red cedars for our regalia, our woven cedar hats, or our headbands; this regalia plays a vital role in our Potlatch ceremonies. The tree of life is often in our artwork, our regalia; it represents the spirit of hope our communities have for our families, our communities, and the other nations interconnected with ours.
The connection between our traditional teachings and protocols around red cedars is very similar to how we support people in mental health distress. A sense of connection, community, dignity, and respect are essential.
So much of a tree’s determinants of health lie within the soil, a place we cannot see. When supporting a student who is very distressed and possibly considering suicide, it is important to remember all of the protective factors they may have below the surface:
- Counselling support
- Family and friends
- Community supports
- Spiritual or religious beliefs or practices
Our role in supporting students with suicidal ideation is to determine the most appropriate resources to help the student, the same way the roots of the tree of life share their resources to the forest around them.
—Jewell Gillies, Musgamagw Dzawada’enuxw of the Kwakwa̱ka̱’wakw Nation (Ukwana’lis, Kingcome Inlet, B.C.)
Video: Live Through This
Live Through This is a series of portraits and true stories of suicide attempt survivors. Its mission is to change public attitudes about suicide. To start this section, you may want to show a short four-minute video of suicide survivors from the Live Through This website. Alternatively, you could share the link with participants prior to the session to help them prepare.
Myths and Commonly Misunderstood Ideas
Because we don’t talk about suicide a lot, people often have a lot of questions and there are a lot of misunderstood ideas and myths about suicide. Let’s take some time to talk about some of these myths.
In small groups, have participants discuss one of the myths below. You could have each group discuss a different myth and then bring their thoughts back to the larger group for a larger group discussion. Also ask them to consider the following two questions:
- What myths or stereotypes exist in society about suicide?
- What questions do you have about suicide?
As a large group, ask people to share their thoughts about the myths and give everyone an opportunity to ask questions. If online, you could have people share thoughts and ideas in chat.
Debrief with the group. Below are some talking points about the myths.
Myth: People who talk about suicide are only trying to get attention. They won’t really do it.
Few people die by suicide without first letting someone else know how they feel. Those who are considering suicide give clues and warnings as a cry for help. In fact, most seek out someone to rescue them. Over 70% who do threaten to carry out a suicide either make an attempt or die by suicide.
It is best to treat talk and threats about suicide seriously. Research indicates that up to 80% of suicidal people signal their intentions to others, in the hope that the signal will be recognized as a cry for help. These signals often include making a joke or threat about suicide, or making a reference to being dead. If we do take someone seriously and ask them if they mean what they are saying, the worst that can happen is we will learn that they really were not serious. Not asking about suicide could result in a far worse outcome.
Myth: If someone is seriously contemplating suicide, they don’t want to make a decision to live.
We know that those at risk for suicide do not necessarily want to die, but do want help in reducing the pain they are experiencing so that they can go on to lead productive, fulfilling lives. There is a lot of ambivalence surrounding the decision to take one’s own life, and by recognizing this, and discussing it, we can help the suicidal person start to recognize alternative options for managing their suffering. Often people who are suicidal are experiencing intolerable emotional pain, which they believe to be unrelenting. They often feel hopeless and trapped. By helping them to recognize and explore alternatives to dying, you are planting the seeds of hope that things can improve.
Myth: Talking about suicide to a person will make them suicidal.
There is no research evidence that indicates talking to people about suicide, in the context of care, respect, and prevention, increases their risk of suicidal ideation or suicidal behaviours. Research does indicate that talking openly and responsibly about suicide lets a person who is potentially suicidal know they do not have to be alone, that there are people who want to listen and who want to help. Most people are relieved to finally be able to talk honestly about their feelings, and this alone can reduce the risk of an attempt.
Myth: If someone makes a suicide attempt, but does not die, they are just looking for attention.
At some level, all suicide attempts are usually because an individual is experiencing high levels of emotional pain and desperation. It is important to treat all attempts as serious. Once an attempt is made at any level of lethality, the risk for suicide or more serious suicide attempts increases significantly.
Myth: Self-harm is always a sign that someone is contemplating suicide.
Self-harm is the intentional and deliberate hurting of oneself. It is very upsetting to notice that someone is self-harming, but self-harm does not necessarily mean a person is thinking about suicide. Self-harm is often a coping method, a way to deal with feelings such as anxiety, anger, or pain. It can also be a way that people communicate their emotional pain and a way to reach out for help. Although self-harm is not the same as suicide, self-harm can become suicide, and it is important that this person get help.
Note: If participants have questions specifically about self-harm, suggest that they talk to you after the session for resources to understand more about it. A very good resource on self-harm is Self-Injury Outreach and Support.
Looking at Statistics
Every expression of suicide needs to be taken seriously because no one can predict who will die by suicide even though many people have had thoughts of suicide at some point in their lives. Anyone can be at risk for suicide. Let’s have a look at some statistics for more insight.
An average of 10 people die by suicide each day in Canada.
For every 1 suicide death there are:
- 5 self-inflicted injury hospitalizations
- 25 to 30 attempts
- 7 to 10 people affected by suicide loss
In the post-secondary context, Canadian data from the 2019 National College Health Assessment tells us that:
- 10.1% of students had seriously considered suicide within the previous 12 months
- 1.9% had attempted suicide within the previous 12 months
- 6.0% intentionally cut, burned, bruised, or otherwise injured themselves within the previous 12 months
(For this survey, 58 Canadian post-secondary institutions self-selected to participate and over 55,000 surveys were completed.)
When we consider gender, Statistics Canada tells us that males account for 75% of suicide, but females account for 58% of hospitalizations for attempted suicide.
Women are three to four times more likely to attempt suicide than men, but men are three times more likely to die by suicide than women. There are several reasons for this:
- Men often use more lethal means of suicide than women.
- Men are less likely than women to seek help when they are struggling.
- Men are often socialized not to talk about their emotions and may mask their stress and deal with emotional pain through harmful behaviours and actions.
Among non-binary students, the suicide rate is very high: 44% of non-binary students had seriously considered suicide, and 17% had attempted suicide in the past year.
What Stats Don’t Tell Us
Stats don’t take into account the impact that suicide has on others. For each death by suicide it has been estimated that the lives of 7 to 10 people will be affected.
The more we have these types of conversations, the more of the iceberg is brought to the surface.
Statistics can quickly show how prevalent suicide or thoughts of suicide are among post-secondary students. The slides include information about suicide in Canada. However, there may be statistics on student mental health and suicide at your institution or in your community that you can use. Or you may want to share information and statistics about groups at higher risk of suicide. Some examples to consider:
- People with experience of abuse, trauma, conflict, or disaster, including bullying, cyberbullying, and peer victimization are at higher risk of suicide.
- Those who have been bereaved or affected by suicide in others may have a higher risk.
Or you may want to use both quantitative data and qualitative data (for example, brief statements from students).
Risk Factors and Protective Factors
Suicide is a complex topic and there is no single cause that makes an individual suicidal. When a person feels helpless or alone, overwhelmed by pain, fear, and suffering, their hope wanes and they may consider ending their life.
Many people experience passing thoughts of ending their lives without ever having any intention to act on those thoughts. Suicidal thinking becomes more concerning when it is persistent and driven by increased emotional distress. When a person’s thoughts become directed toward how and when they might kill themselves and actual gestures or attempts elevate the overall level of risk.
Factors that may increase risk of suicide:
- Prior suicide attempt
- Triggering life events (losing a loved one, physical illness, discrimination, harassment)
- Trauma (violence, abuse, or events that affect generations of one’s family)
- Mental illness, such as depression
- Alcohol or drug addiction
- Chronic physical illness
- Barriers to accessing care
- Lack of support from family, friends, community
- Personal identity struggles (cultural, sexual)
- Feelings of isolation
Protective factors include:
- Access to appropriate mental health services and support.
- A sense of hope, purpose, belonging, and meaning.
- Sense of belonging and connectedness with family, culture, community, and friends.
- Supportive environments and healthy relationships.
- Skill in problem solving, conflict resolution, and non-violent handling of disputes.
When we talk about mental health and suicide risks, we also need to be aware of factors like race, sexual orientation, social class, age, disability, and gender and the unique life experiences and stressors that accompany them. Some students face inequality, discrimination, and violence because of their race or gender orientation. These unique and specific stressors impact mental and physical health, and these students often experience greater mental health burdens while at the same time facing more barriers to accessing care. Research and statistics tell us that suicide risk is higher for Indigenous and LGBTQ2S+ (lesbian, gay, bisexual, transgender, queer, two-spirit) than it is for the general population.
Suicide among Indigenous people is significantly higher than the general population. Estimates suggest that, in some years, the suicide rate for Indigenous people in specific communities is as much as 30% higher than that for non-Indigenous people.
Suicide rates are highest for youth and young adults (15 to 24 years) among First Nations men and Inuit men and women. However, there is great variability in suicide rates at the community level; some Indigenous communities may have a very high suicide rate; other communities may have a very low rate.
For Indigenous communities, high rates of suicide are connected to a variety of factors including the historical and ongoing trauma from colonialism, systemic racism, discrimination, and the loss of culture and language. The impact of residential schools and other colonial policies have created ongoing adversity for Indigenous people, and these effects have been passed on from one generation to the next, causing intergenerational trauma.
Many Indigenous people lack trust in educational and health care institutions because of the negative or traumatic experiences they or family and friends have experienced in the past. The 2020 report In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care reported on the widespread systemic racism against Indigenous peoples in the B.C. health care system. The study reported that 84% of Indigenous people described personal experiences of racism and discrimination that discouraged them from seeking necessary care.
It is important to note, however, that while the suicide rate is higher for Indigenous people compared with non-Indigenous people, not all Indigenous communities have regular incidents of suicide. In communities where there is a strong sense of culture, community ownership, and other protective factors, it is believed that there are much lower rates of suicide and sometimes none at all.
People who are LGBTQ2S+ are at a much higher risk than the general population for mental health disorders, substance abuse, and suicide. Homophobia and negative stereotypes about being LGBTQ2S+ can make it challenging for a student to let people know this important part of their identity. When people do openly express this part of themselves, they worry about the potential of rejection from peers, colleagues, and friends, and this can exacerbate feelings of loneliness. Health needs may be unique and complex for some LGBTQ2S+ people, and health care settings can feel unsafe or uncomfortable for many.
Lesbian, gay, and bisexual youth are more at risk for suicide than their straight peers. They are five times more likely to consider suicide and seven times more likely to attempt suicide.
Transgender people are at an even greater risk for suicide as they are twice as likely to think about and attempt suicide than LGB people. Studies have shown that 22% to 43% of transgender people have attempted suicide. Transgender people face unique stressors, including stress from being part of a minority group, as well as stress related to not identifying with one’s biological sex. Transgender people also experience higher rates of discrimination and harassment than their cisgender counterparts and, as a result, experience poorer mental health outcomes.
While there is a growing awareness of the needs and challenges faced by LGBTQ2S+ community members, much still needs to be done to create truly inclusive and safe spaces within health and educational environments.
What We Need to Keep in Mind
We need to take care to understand and acknowledge oppressions faced by Indigenous people, LGBTQ2S+, people with disabilities, and people from racialized and other marginalized groups. By providing a culturally safe environment, we can all play a role in ensuring that each student feels their personal, social, and cultural identity is respected and valued.
It is helpful to know the campus and community resources for students from marginalized groups. Connecting an Indigenous student to an Elder or to someone from Indigenous services or introducing an LGBTQ2S+ student to a pride centre on campus can help to reduce feelings of isolation and help students feel heard and supported. We’ll talk more about supports and referrals a bit later in the session.
Either in small groups or as a large group, ask participants to discuss the following:
- How do you react to hearing this information about suicide? Does it ring true for you in terms of your own experiences with students?
- Have you found yourself in a situation where you were trying to support someone with these concerns or other serious concerns?
- What’s it like for you when you’re trying to help someone else out? What do you need in order to feel more helpful to others?
- This chapter was adapted from Let’s Talk: A Workshop on Suicide Intervention by Dawn Schell, University of Victoria.
- New text: “Risk Factors and Protective Factors,” “Marginalized Groups” by Barbara Johnston. “The Tree of Life” by Jewell Gilles. CC BY 4.0 license.
- Slides 8 and 18: Trees and sunshine by Richs5812 is in Public Domain.
- Slides 10 and 11: Person by asianson.design is licensed under a CC BY 4.0 license.
- Slide 10: Map of Canada, vector map. Modified by Lokal_Profil is licensed under a CC BY-SA license.
- Slide 15. Iceberg in the Arctic with its underside exposed by AWeith is licensed under a CC BY-SA license.
- What is Live Through This by Dese’Rae L. Stage is licensed under a Standard YouTube License.
- Statistics Canada. (2019, July 22). Suicide in Canada. https://www.canada.ca/en/public-health/services/publications/healthy-living/suicide-canada-infographic.html ↵
- American College Health Association. American College Health Association-National College Health Assessment II: Canadian Reference Group Data Report Spring 2019. Silver Spring, MD: American College Health Association; 2019. https://www.acha.org/documents/ncha/NCHA-II_SPRING_2019_CANADIAN_REFERENCE_GROUP_DATA_REPORT.pdf ↵
- Canadian Mental Health Association. (2016). Preventing suicide. (2019, July 22). https://cmha.ca/documents/preventing-suicide ↵
- Buddy Up. (n.d.) The gender paradox. https://www.buddyup.ca/learn/ ↵
- McCreary Centre Society. (2018). B.C. adolescent health survey. https://www.mcs.bc.ca/about_bcahs ↵
- Statistics Canada. (2019). Suicide among First Nations People, Métis and Inuit (2011–2016): Findings from the 2011 Canadian Census Health and Environment Cohort (CanCHEC). https://www150.statcan.gc.ca/ n1/daily-quotidien/190628/dq190628c-eng.htm ↵
- Turpel-Lafond, M. E. (2020). In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care. https://engage.gov.bc.ca/app/uploads/sites/613/2021/02/In-Plain-Sight-Data-Report_Dec2020.pdf1_.pdf ↵
- Kirmayer, L., et al. (2007). Suicide among Aboriginal people in Canada. Aboriginal Healing Foundation. ↵
- Suicide Prevention Resource Center. (2008). Suicide risk and prevention in gay, lesbian, bisexual and transgender youth. Education Development Center, Inc. http://www.sprc.org/sites/default/files/migrate/library/SPRC_LGBT_Youth.pdf ↵
- Haas, A., et al. Suicide and suicide risk in lesbian, gay, bisexual and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1),10-51. DOI: 10.1080/00918369.2011.534038; McNeill, J. et al. (2017). Suicide in trans populations: A systematic review of prevalence and correlates. Psychology of Sexual Orientation. DOI:10.1037/sgd0000235.; Irwin, J. et al. (2014). Correlates of suicide ideation among LGBT Nebraskans. Journal of Homosexuality, 61(8), 1172–1191. ↵
- Bauer, G., et al. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven suicide risk sampling study in Ontario, Canada. BMC Public Health. DOI: 10.1186/s12889-015-1867-2. ↵