County of Oxford 
Suicide Prevention Plan 


Why would a small group of dedicated individuals believe that by working together 
we can change the world? 

Because, throughout history, it is the only thing that ever has. 

Margaret Mead 

Draft September 10, 2010 



Table of Contents 

I. Acknowledgements 
II. Dedication 
III. Introduction 
IV. Guiding Principles 
V. Prevention Plan: Goals & Objectives 
Appendix #1 – Current Suicide Prevention Initiatives in Canada 
Appendix #2 – Canada Wide Crisis/Distress Resources 
Appendix #3 – History – How did we get to where we are today? 
Appendix #4 – National Strategy Guidelines in Other Countries 
Appendix #5 – References used by CASP 
Appendix #6 – Health Canada’s Canadian Institutes of Health Research (CIHR) 
Appendix #7 – Oxford Suicide Prevention Coalition 

I Acknowledgements 

The Suicide Prevention Coalition of Oxford County wishes to acknowledge, with thanks, the work 
of the Canadian Association of Suicide Prevention (CASP) for its hard work and dedication in the 
area of suicide prevention. More specifically, we wish to acknowledge the work of the Association 
in developing the Blueprint. For a time line of the work done by CASP and others please see 
the Appendix. 

In addition, the Oxford County Suicide Prevention Coalition has reviewed the plans developed in 
Waterloo Region, The Region of Niagara and The Region of Hamilton-Wentworth and we owe a 
debt of gratitude to those groups. 

As we move through this process we are reminded of a story. There was a man sitting on a river 
bank when suddenly he heard cries for help. He looked up to see a man floating in the river. 
Without hesitation he jumped in the river to save the man from floating downstream. As he stood 
on the shore with the first man, he heard another cry for help and then a third and a fourth. He 
jumped back in the river trying to save each man. Soon a crowd gathered and others joined in, each 
doing what they could to rescue people from the river. Suddenly the first man started to walk up 
river. Those who had joined him cried out: “Why have you stopped? Many people still need your 
help.” “Yes”, he said “but there are enough people helping here. I need to go up stream and stop 
people from getting into the river in the first place”. 

We need your continued help. It is time for us to ‘head up river’! 

II Dedication 

To those people who find themselves struggling with thoughts of suicide and to those who act on 
those thoughts we dedicate this document. 

To all the people who work with those who are touched by the death of someone by suicide we 
dedicate this document . 

To each person who tries to help another with thoughts of suicide we dedicate this document. 

To those people for whom the pain and hopelessness and despair was too great and have died by 
suicide we dedicate this document. 


III Introduction 

Suicide is the triumph of pain and fear and loss over hope, but it is almost always preventable 
through caring, compassion, commitment and community. 

Rationale for the Oxford County Suicide Prevention Plan 

The World Health Organization's (WHO) first report on violence and health, published in October 
2002, indicates that suicide is the single greatest cause of violent death around the globe; more 
deaths occur annually than all war casualties and homicides combined. 

The report states that suicide is one of the leading causes of death worldwide and therefore is an 
important public health problem. Of the 82 countries reporting suicide statistics to the WHO, 
Canada ranks 26th putting it in the top third. Canada’s national government has been aware of 
suicide as a serious community issue for close to two decades, having published a leading-edge 
national suicide task force report in 1987 and comprehensive update in 1994. 

Suicidal behavior is an action which has a fatal outcome. It is not an illness and does not result 
from a single cause. Suicidal actions (resulting in fatal and non-fatal outcomes) should be viewed in 
the context of mental health issues and other conditions of risk -such as social isolation, biological 
vulnerability, trauma and stress, family violence, illness, and substance abuse -that interact in 
complex bio-psychosocial ways. 

The tragic and complex nature of a suicide action has traumatic and rippling consequences, both for 
individuals and for those around them. The death of one person affects parents, children, siblings, 
and grandparents, in addition to relatives, friends, teachers, co-workers and others known to the 
individual. Although descriptive accounts are available, neither Canadian nor international research 
has focused sufficiently on the impact of suicide on the well-being of those left behind. 

Suicide is generally seen as a preventable action, the causes of which lie in some combination of 
biological, psychosocial and community factors. There is a need for better understanding of the 
nature of suicide and for a national strategy designed to mobilize policies and services. We need to 
affect public attitudes toward suicide and its prevention if the impact on Canadians is to be reduced. 
A strategy requires a broad array of individuals and organizations, public and private, to join in the 
common cause of prevention through the coordination and development of appropriate services in 
communities across the country. 

Suicide in Canada 

In the past three decades, more than 100,000 Canadians died by suicide. These deaths include our 
children and our parents, our family members, our friends, our neighbours and people from all 
socioeconomic, age, gender, culture and ethnic groups. No part of our society is immune. Suicide 
affects all of us. It remains among Canada’s most serious public health issues. 


For too long, discussion of suicide has involved secrecy, stigma and taboo. Through our silence, 
and fueled by our fears, ignorance has resulted in much suffering. Now is the time to confront the 
silence. We must all be willing to learn. We must all be willing to educate ourselves and become 
ready to move into action to prevent suicide and to comfort the suffering. 

Suicide is a complex problem involving biological, psychological, social and spiritual factors. No 
one perspective has the corner on truth, but taken together they provide much knowledge. We know 
that those at risk for suicide experience overwhelming emotional pain. They do not necessarily 
want to die, but do want help in reducing the pain so that they can go on to lead productive, 
fulfilling lives. Tragically, when someone dies by suicide the pain is not gone, but merely 
transferred to family, friends and community. The grief of those bereaved by suicide requires 
compassion, understanding and support to help minimize its impact. 

Canadian statistics 

1. The suicide rate in Canada is higher than in many industrialized countries. 
The Canadian suicide rate is near the middle of all countries and in the top third of the highest rates 
of countries reporting to the WHO. The Canadian suicide death rate per 100,000 of population has 
increased 73% from an average of 7.4 in the 1950’s to an average of 12.9 throughout the 1990’s. 
The rate increased significantly from the 1960’s to the 1970’s but has remained relatively stable 
throughout the 1980’s and 1990’s. 

2. Over 4,000 Canadians die by suicide every year. 
The Canadian population has shown a steady increase from less than 14 million in 1950 to just over 
30 million in 1999, an increase of 122%. The numbers of suicide deaths each year have more than 
tripled in the same period from just over 1,000 to over 4,000, while the population-adjusted rates of 
suicide have increased from 8.9 per 100,000 in 1950 to 13.13 in 1999, an increase of almost 50%. 
The most significant 10-year average increase was from the 1960s to the 1970s, which stabilized 
through the 1980s and showed the beginning of a slight downward trend in the 1990s; this 
downward trend needs to be continued and sustained. 

There are well over 4,000 suicide deaths each year representing 2% of all deaths by Canadians. 
Canada loses on average 11 people a day to suicide, a figure that has been tragically predictable 
throughout the 1990s and into the early 2000s. Many actual suicides are not reported as such. 

Statistics Canada suicide data go back to 1924 but were incomplete until 1956 when territorial data 
was included. Female suicide rates from 1924 to 1950 varied from a high of 7 to a low of 4.8 per 
100,000, very similar to the current rates. Male suicide rates from 1924 to 1950 ranged from a high 
of 24 in the late 1920s to a low of under 15 during the Second World War. By the end of the 1990s, 
they were again approaching 20 per 100,000 . 


3. Over 400,000 Canadians deliberately harm themselves every year. 
Research shows that the rates of deliberate self-harming behaviours, including serious suicide 
attempts, may be 100 times higher than rates of suicide deaths. The large number of people 
engaging in self-harming actions may be one result of the increased levels of stress and resulting 
mental health problems evident in our current society (Bland, Newman, Dyck, 1994; Kerkhof et al, 
1994). 

Although it is difficult to arrive at accurate national figures for attempted suicide, a review of 
hospital discharge records provides another look at the magnitude of the problem. In 1998/99 a 
total of 22, 887 hospital discharges were related to suicide and intentional self-inflicted injury, 
close to 6 times the number of suicide deaths. Approximately 9% had been discharged in that year 
for one previous attempt and among these repeated attempts, approximately 23% had been 
discharged on at least three occasions following a suicide attempt. Recent (2002) national health 
survey information indicates that 3.7% of the Canadian population over 15 years has thought of 
suicide in the past 12 months. 

4. Over 2,800,000 Canadians are affected by suicidal behaviour every year. 
Using a conservative estimate of seven individuals who have been personally affected by a suicide 
death or act of intentional self-harm, over 2.8 million Canadians are affected annually. 

Suicide and acts of self-harm affect all of us, families, friends, classmates and co-workers. Suicidal 
behaviours strain our health care system and increase the level of stress in society 

5. Suicide is a leading cause of death for Canadians between ages 10 and 49. 
In 1995, suicide was the leading cause of death for Canadian males aged 10 to 49. Cancer, motor 
vehicle collisions and HIV/AIDS were the next most common causes of death. At the end of the 
1990s, suicide was the leading cause of death for men between 25 and 29 years and 40 to 44 years, 
and for women between 30 and 34 years. For young people between 10 and 24 years, suicide was 
the second leading cause of death for both males and females, surpassed only by motor vehicle 
collision deaths. For young First Nations people, suicide was the leading cause of death for youth 
between 10 and 19 years, accounting for 38% of all deaths for that age group, and higher than the 
30% killed in motor vehicle collisions. 

As we enter a new century, suicide is ranked third after cancer and heart disease across all ages in 
potential years of life lost for men; for women, it is fourth after cancer, heart diseases, and motor 
vehicle traffic collisions. Suicide was ranked second (725) behind unintentional injuries (1,036) for 
the greatest number of potential years of life lost per 100,000 for males. For females, suicide (179) 
was fourth behind unintentional injuries (375 years), lung cancer (344 years) and breast cancer (339 
years). 


Among First Nations people in 1999, the potential years of life lost was higher than all cancers 
combined and 50 percent higher than potential years lost to all circulatory disease. First Nations 
populations lost three times as many potential years of life to suicide as did Canadians overall. For 
First Nations people (on-reserve) suicide (1,495 years) ranked second after unintentional injuries 
(3,218 years) for the greatest number of potential years of life lost per 100,000. 

5. Suicide is the second leading cause of death among Canadian youth aged 10-24. 
Fatal injuries from suicidal behaviour closely follow motor vehicle collision injuries as the most 
likely cause of death for young Canadians. While the numbers of MVC deaths have been falling for 
several years, youth suicide rates in the 10-19 year range have been increasing. 

6. Males are more likely to die by suicide but females are more likely to survive a suicide 
attempt. 
Since the 1950s, Canada’s suicide rates for males have been at least three times higher than for 
females, reaching a four times higher peak in the 1990s and dropping back to a 3.5 times higher 
ratio in 2001 due to a lower number of male deaths (2869) and a slight increase in female deaths 
(819). Males are most likely to use hanging and firearms in their suicide acts, resulting in fewer 
opportunities for rescue. 

Females are also at high risk for suicide actions but tend to use less immediately lethal methods in 
their suicide attempts and are thus more likely to survive. They are more likely to use drugs, 
poisons and gases in their suicide acts resulting in better chances to prevent death with effective 
medical intervention. Although females have some tendency to utilize more lethal and less 
reversible methods in recent years, they are more likely to take advantage of community suicide 
prevention services and to ask for help even after initiating a suicide attempt. Males are less likely 
to ask for help from any source at any time. 

7. Suicide is the third leading cause of death among adults in their primary parental years 
from ages 25-49. 
Suicide follows cancer and diseases of the circulatory system as one of the major causes of death in 
this age group. One of the primary factors which enable people to manage the stress evident in 
daily life is a stable home relationship. The suicide of a family member is one of the most 
significant stressors a family can face. 


8. Suicide deaths and attempts cost the Canadian economy over $14.7 billion annually. 
Several Canadian and US studies have estimated the cost of death due to AIDS, gunshot wounds 
and suicide. The estimated cost of a suicide death ranges from $433,000 to $4,131,000 per 
individual depending on potential years of life lost, income level and effects on survivors. 

The estimated cost of attempted suicide ranges from $33,000 to $308,000 per individual depending 
on the hospital services and rehabilitation required, as well as family disruption and support 
required following the attempt. Psychological distress and ongoing mental health problems may 
result in long term treatment and care for the suicidal individual and family members. Suicidal 
behaviour in one family member may result in other family members choosing similar responses to 
distress in the future. 

9. Suicide can be prevented. 
Prevention requires a comprehensive strategy guided by federal policy and implemented with full 
federal participation. The conditions evident in the Canadian population which lead to suicidal 
actions are also manifested in other social problems such as violence against others, substance 
abuse, delinquency, employment disruption, poverty and family breakdown. A national strategy 
that contributes to the reduction of suicide may also contribute to the reduction of many other social 
problems. 

10. Deaths by suicide in Oxford County. 
The following chart provided by the Office of the Chief Coroner for the Province of Ontario shows 
the number of deaths by suicide in Oxford County. However, it does not include Woodstock, 
Tillsonburg or Ingersoll, which are the population centres of the County. It would be reasonable 
then to assume that for the entire County of Oxford the number of deaths by suicide would be 
higher than those listed below. This speaks to the need to ensure that accurate data is gathered and 
easily accessed. 

YEAR TOTAL 
2000 8 
2001 9 
2002 12 
2003 10 
2004 16 
2005 15 


IV Guiding Principles 

1. Suicide prevention is everyone’s responsibility. 
2. As Canadians we will respect our multicultural and diverse society and accept responsibility to 
support the dignity of human life. 
3. Suicide is an interaction of biological, psychological, social and spiritual factors and can be 
influenced by societal attitudes and conditions. 
4. Strategies must be humane, kindly, effective, caring and should be: 
a) Evidence-based. 
b) Active and informed. 
c) Respectful of community and culture-based knowledge. 
d) Inclusive of research, surveillance, evaluation and reporting. 
e) Reflective of evolving knowledge and practices. 
5. Many suicides are preventable by knowledgeable, caring, compassionate and committed 
communities. 
V The Plan: Goals and Objectives 

(A) Awareness and Understanding: Goal #1 
To promote awareness in Oxford County that suicide is our problem and is preventable. 

Objectives: 

1.1 We will have a coordinated public awareness campaign that will reach the majority of the 
population and target special populations. 
1.2 Convene an annual forum on special target populations and specific issues as needed 
(example: physician education on risk assessment). 
1.3 Increase the number of public and private institutions and volunteer organizations active in 
suicide prevention. 
1.4 Develop an awareness program to coincide with World Suicide Prevention Day. 
1.5 Increase awareness and support for persons suffering from mental illnesses, substance use 
disorders, trauma and grief. 

(A) Awareness and Understanding: Goal #2 
To develop broad-based support for suicide prevention and intervention. 

Objectives: 

2.1 Ensure a broad representation of government, private and public stakeholders in further 
development, adoption and implementation of the Oxford County Suicide Prevention Plan. 
2.2 Increase the number of Oxford County professional, voluntary and other groups that integrate 
suicide prevention activities into their ongoing programs and efforts. 
2.3 Identify and increase the number of advocacy activities for suicide prevention in Oxford 
County. 
(A) Awareness and Understanding: Goal #3 
To develop and implement a strategy to reduce stigma associated with all suicide prevention, 
intervention and bereavement activities. 

Objectives: 

3.1 Increase the proportion of the public who value mental, physical, social, spiritual and holistic 
health. 
3.2 Improve public understanding of mental health, treatment for depression, other mood disorders 
and mental illness, substance abuse, and suicide prevention services that are fundamental and 
essential components of health care. 
3.3 Improve public understanding that to break the silence surrounding suicide increases realistic 
opportunities to save lives and reduce suffering. 
(A) Awareness and Understanding: Goal # 4 
To increase media knowledge regarding suicide. 

Objectives: 

4.1 Promote media news packages and training to increase knowledge and sensitivity regarding 
suicide. 
4.2 Create a community media award for excellence in reporting as it relates to suicide and mental 
health. 

11 
(B) Prevention and Intervention: Goal #1 
To develop, implement and sustain community-based suicide prevention programs while 
respecting diversity and culture at the local level. 
Objectives: 
1.1 The development of special emphasis on : 
. persons suffering depression, other mood disorders and mental illness. 
. those with a history of suicidal behaviour or multiple suicidal acts. 
. gay, lesbian, bisexual, transgender, transsexual, intersexed and two-spirited persons. 
. youth, young adults, family, community service providers, employers, 
. schools 
. in-home and community based services for seniors, persons with disabilities. 
. police and emergency response. 
. mental health, medical personnel, and other health care providers. 
1.2 The development of a working agenda, timeline and target dates for implementation of these 
objectives. 
(B) Prevention and Intervention: Goal # 2 
To reduce the availability and lethality of suicidal methods. 
Objectives: 
2.1 Educate the public to reduce access to lethal means. 
2.2 Support CASP as it advocates for the development and use of technology to reduce the 
lethality of means: for example firearm locks, carbon monoxide shut-off controls, bridge barriers, 
and medication containers. 
2.3 Educate the public about the specific risk of harm and death by suicide any time there is a 
firearm in the home or otherwise available. 
(B) Prevention and Intervention: Goal #3 
To increase training for recognition of risk factors, warning signs and at-risk behaviours and for 
provision of effective intervention, targeting key gatekeepers, volunteers and professionals. 
Objectives: 
3.1 Increase the number of professional groups in the training and management of suicide risk and 
identification and promotion of protective factors. 

12 
3.2 Increase the number of employers in the training and management of suicide risk and 
identification and promotion of protective factors. 
3.3 Increase the training and management of suicide risk and of identification and the promotion of 
protective factors within schools and education systems, and for: 
. youth, family, community service providers, employers. 
. school districts and private school associations, colleges and universities. 
. in-home and community based services for seniors. 
. persons with disabilities. 
. police and emergency response. 
. mental health, medical personnel, and other health care providers. 
(B) Prevention and Intervention: Goal #4 
To improve access and integration with strong linkages between the continuum-of-care 
components/services/families. 
Objectives: 
4.1 Advocate for follow-up within twenty-four hours of discharge or other transition of care for 
everyone deemed to be high risk, or with severe mental illness or history of self-harm within the 
previous three months, or with face-to-face contact within a maximum of seven days. 
4.2 Support and advocate for the development guidelines and protocols to actively seek out and 
respectfully utilize collaborative input from families and friends. 
(B) Prevention and Intervention: Goal# 5 
To promote intervention and service delivery for high-risk groups. 
Objectives: 
5.1 Support interventions and coordinated service delivery for persons with mental illness, mood 
disorders, substance abuse and addiction, and dual diagnosis disorders ( those with Intellectual 
Disability and Mental Health concerns). 
5.2 Support interventions and coordinated service delivery for persons experiencing severe distress 
as gay, lesbian, bisexual, transgender, transsexual, intersexed and two-spirited persons. 

(B) Prevention and Intervention: Goal #6 
To increase crisis intervention and support. 

Objectives: 

6.1 Increase the number and training of programs and service providers for those affected by 
suicidal behaviour. 
6.2 Support crisis and support networks and certification standards that are appropriate to the needs 
of this community. 
6.3 Support the development of a crisis resource data base accessible to all crisis lines and crisis 
intervention facilities. 
6.4 Support the development of structures for families living with suicidal people. Acknowledge 
their roles both as caregivers and as contributing members of the care team. 
(B)Prevention and Intervention: Goal #7 

To increase services and support to those bereaved by suicide. 

Objectives: 

7.1 Ascertain the number of support services, both immediate and longer-term, to those impacted 
by a suicide. 
7.2 Review the needs of first responders regarding death notifications, funeral arrangements, 
community systems of support and aftercare. 
7.3 Review the need for information packages for funeral directors, churches, schools and other 
community resources to improve services, education and support to those bereaved by suicide. 
(B) Prevention and Intervention: Goal #8 
To increase the number of primary prevention activities. 

Objectives: 

8.1 Support training events which promote resiliency and protective factors. 
8.2 Increase connections and networking and improve cooperation and communication between 
suicide prevention and intervention programs, and services and associations to those programs that 
promote community wellness, public health and injury prevention. 

(C) Knowledge Development and Transfer: Goal #1 
To improve and expand surveillance systems. 

Objectives: 

1.1 Support the development of consistent standards and protocols for collecting information on 
suicide deaths, non-fatal attempts and ideation. 
1.2 Support the development of standards for coroners to assist in accurately determining and 
reporting on cause of death. 
(C) Knowledge Development and Transfer: Goal #2 
To promote & support the development of effective evaluation tools. 

Objective: 

2.1 Support communication between survivors, community resources and researchers to facilitate 
knowledge transfer and knowledge uptake. 
(C) Knowledge Development and Transfer: Goal #3: 
To promote and develop suicide-related research. 
Objectives: 

3.1 Support the study and reporting of risk factors, warning signs and protective factors for 
individuals, families, communities and society. 
3.2 Support efforts to increase opportunities including scientific journals, conferences, workshops 
and training for dissemination of data and knowledge from surveillance, evaluation and research 
activities. 

Appendix #1 
Current Suicide Prevention Initiatives in Canada 

Atlantic Canada 
New Brunswick 

The Mental Health Commission offers suicide intervention training for caregivers in English and 
French. A Provincial Suicidologist has recently been appointed. 

Newfoundland 

Suicide intervention training by independent trainers. 

Nova Scotia 

There is now a province-wide network linked through a local newsletter, Suicide Alert, an annual 
symposium, NS Symposium on Suicide, and a leadership/coordinating committee, the N.S. 
Community Network to Address Suicide. This inter-agency type of coordination, while a relatively 
new and loose arrangement, is province-wide. 

Prince Edward Island 

Community crisis services and independent suicide intervention training. 

Others 

Suicide intervention training by independent trainers along with crisis and distress centres in many 
communities in Atlantic Canada. There is no standardized training program or established 
minimum standards for staff or volunteers. 

Central Canada 
Quebec 

The only funded provincial suicide prevention association in Canada. Established provincial policy 
with designated funding. Established network of community crisis/distress centres. Annual 
conferences and awareness week activities. Independent suicide intervention training. Government 
funded suicide prevention research centre. Repertoire of available resources produced by the 
Conseil permanent de la jeunesse. 


Ontario 

Independent suicide intervention and bereavement training. Established network of crisis/distress 
centres. Some regional suicide prevention organizations and initiatives such as the Hamilton 
Suicide Prevention Council, the Toronto Council on Suicide Prevention, the Ottawa-Carleton 
Regional Inter-Agency Suicide Prevention Committee, and The Arthur Sommer Rotenberg 
Research Chair at the University of Toronto (established through private funding). The recently 
established, unfunded, Ontario Suicide Prevention Network is working to improve education, 
networking and sharing of suicide prevention resources. 

Western Canada 

Manitoba 

Suicide prevention training and resources responsibility with mental health staff in government and 
regional responsibility for direct services through Regional Health Authorities without designated 
funding for suicide prevention services. Independent trainers and crisis/distress centres provide 
services. 

Saskatchewan 

Government coordinated Adolescent Suicide Awareness Program (ASAP) with a designated youth 
suicide prevention facilitator in each health district and a part time provincial coordinator. 
Corporate funded youth suicide prevention program (Friends For Life) currently winding down 
with the end of funding. Independent trainers and crisis/distress centres work throughout the 
province. 

Alberta 

Provincial programs since 1981 with internationally recognized components but no formal 
provincial policy. Active components include: Coordinated Community Outreach, Information and 
Training (The Alberta Model), but little funded research. The Suicide Information & Education 
Centre (SIEC) is the only provincially funded suicide specific resource centre in Canada and the 
Suicide Prevention Training Programs (SPTP) was the first provincially funded program to 
develop, deliver and coordinate gatekeeper and caregiver training in suicide intervention, 
postvention and awareness. Independent crisis/ distress centres provide service. Some staff training 
at Solicitor General and Child Welfare agencies. Intervention training in some school systems. 

British Columbia 

The Ministry of Health funds the BC Suicide Prevention Program which is administered through 
the University of British Columbia to provide leadership for the province in the area of youth 
suicide prevention. Encourages community consultation and support, education and skill 
development, information and research, and provincial coordination and monitoring. Assists 


and supports the development of community suicide prevention services and coordinates 
government funded Community Wide Suicide Prevention Pilot Projects. Developed a manual of 
Best Practices in Youth Suicide Prevention. 

The North 
Yukon Territory 
Independent suicide intervention training with some government departments supporting staff 
training 

Northwest Territories 

A cooperative government/foundation suicide intervention training initiative in final stages of 
training for trainers. Volunteer crisis/distress services in some communities and some independent 
training offered. 


Appendix 2 

Canada Wide Crisis/Distress Resources 

The Canadian Association for Suicide Prevention (CASP) 

A non-profit association dedicated to reducing suicidal behaviour. 

Choosing Life: Special Report on Suicide Among Aboriginal People 


The Royal Commission on Aboriginal Peoples Report on Suicide which contains many 
recommendations. 

Corrections Services Canada 

Suicide intervention training for staff and inmates, utilizing the LivingWorks suicide intervention 
program, is offered in the Atlantic, Ontario and Prairie regions. 

Crisis/Distress Centres 

Communities across Canada have established Distress/Crisis centres to address suicidal behaviour 
and other crisis situations. These are primarily operated by a large component of volunteers with 
few paid professional staff. Training is not standardized. There is no standardized training program 
or established minimum standards for staff or volunteers and standards are set individually by each 
agency. There are no universal Canadian standards or external accreditation and evaluation criteria 
on a national level. A small number of distress centres have been certified by the American 
Association of Suicidology, but there is no other Canadian certification standard. 

In Oxford County, Crisis Services are provided by the Crisis Team of the Canadian Mental Health 
Association – Oxford County Branch. This is a team of Mental Health professionals and is 
available 24 hours a day by telephone and is a mobile service as well. CMHA Oxford is accredited 
by Accreditation Canada a National Healthcare Accrediting body. 

(Tele-care Oxford disbanded several years ago; it had served as a distress line with volunteers.) 

Government of Canada 

Established the Task Force on Suicide in Canada which resulted in the publication of the report 
Suicide In Canada, 1987 and the Update in 1994. Some suicide research has been funded. National 
meetings have been hosted to discuss suicide prevention. Co-hosted a special workshop on suicide-
related research in 2003. 

Kids Help Line 

A toll-free professionally staffed crisis line to assist youth. 


LivingWorks Education, Inc. 

A public service corporation providing research and development services, as well as training and 
support for national and international independent suicide intervention trainers. 

CMHA Oxford provides 2 LivingWorks education programs: SafeTalk and ASIST. Both programs 
deal with suicide awareness and intervention training and are offered by CMHA staff. All CMHA 
Oxford staff are trained in ASIST along with many others in Oxford County who have been trained 
to provide suicide intervention. 

LPAC ~ Legal Profession Assistance Conference of the Canadian Bar Association 

LPAC’s 1997 Lawyer Suicide Study, by Dr. Adrian Hill, LSM, Ph.D, Juris.D., ICADC, identified a 
rate of death by suicide among older male lawyers at a rate nearly six times Canada’s national 
suicide rate. LPAC established a comprehensive suicide prevention and bereavement support 
program including education, training and web-based learning as well as professional 
counseling and peer support. The LPAC program has been the catalyst for this CASP Blueprint 
project. 

RCMP 

The Aboriginal Police Service of the RCMP provides five-day suicide prevention conferences in 
aboriginal communities, managed and delivered by SPTP in Calgary. Aboriginal trainers are used 
and community members are trained to establish and operate their own suicide prevention services. 

SIEC 

The Suicide Information and Education Centre of the Centre for Suicide Prevention provides a 
collection, database search, document delivery service and provides suicide prevention information 
via the Internet, on CD-ROM, and through a variety of publications and serials. 

SPTP 

The Suicide Prevention Training Programs of the Centre for Suicide Prevention develops and 
delivers caregiver training through a variety of workshops ranging from two hours to five days. 
SPTP also manages a network of trainers offering caregiver training across Canada and worldwide. 
Workshops include Suicide Intervention, Suicide Bereavement, Awareness, Adolescent Suicide, 
Elderly Suicide, Surviving Suicide, Crisis Management and others. 

Suicide in Canada, Leenaars et al., 1998 

A compilation of articles by Canada’s leading experts. This book makes a strong call for action 
from all segments of our population. 


Appendix 3 
History — How did we get to where we are today? 
1987 

United Nations Guiding Principles for Developmental Social Welfare Policies and Programmes in 
the Near Future (UN, 1987) 

1989 

UN General Assembly reaffirms the Guiding Principles 

1991 

The UN General Assembly approved the Guiding Principles as a major framework for action in 
developmental social welfare 
at the local, national, regional and inter-regional levels to address: 

• Widespread stress and anxiety causing increased incidence of individual dysfunction, including 
rising rates of suicide among 
young people. 
• Decline in the capability of many families and communities to provide adequate care for their 
younger members. 
• The absence of comprehensive national strategies to prevent and resolve severe dysfunctional 
conditions, including suicide. 
• UN Centre for Social Development and Humanitarian Affairs requested help to prepare a global 
review of social welfare services and make recommendations on areas of concern set forth in the 
1987 Guiding Principles. 
•The Secretary General of the UN called on countries to formulate social policy strategies that 
would deal with prevention as well as care and rehabilitation. 
• The UN invites LivingWorks and SIEC to organize and host inter-regional expert meeting on 
suicide prevention. 
1993 

A Calgary based group organized and conducted a five day Inter-Regional Expert Meeting to 
develop a policy guideline for national strategies on suicide prevention that could be adopted by 
countries from all regions of the world. 


1996 

Publication of the guidelines in the United Nations document Prevention of Suicide – Guidelines 
for the formulation and implementation of national strategies. 

1996 

Publication of the book Global Trends in Suicide Prevention -Toward the Development of 
National Strategies for Suicide Prevention, edited by R.F. Ramsay, and B.L. Tanney. 

1998 

Health Canada commissioned and received a report outlining a four-stage process for the 
development of a national strategy for suicide prevention, which would include: 

1. A study of the economic burden of distress and suicide in Canada. 
2. Informal consultation among federal, provincial/territorial departments and major stakeholders 
on the feasibility of a national strategy. 
3. The establishment of a coordinating body to guide the development. 
4. The development and implementation of the strategy. 
2003 

CASP embarks on a blueprint strategy to be released at CASP meeting in 2004. 

2005 

Dr. William McLeish, one of Oxford County’s coroners, had concerns over suicides in Oxford 
County and with the support of his faith community an invitation was sent to various community 
stakeholders to attend a meeting on November 15, 2005. 

Representation was present from a good cross-section of the county including mental health 
professionals, psychiatry, faith communities, police services, education, suicide survivor family 
members and community volunteers. 

Following this initial meeting several individuals continued to meet with the establishment of the 
Oxford Suicide Prevention Coalition in 2006. 

2010 

The Oxford Mental Health and Additions Network supported the concept of a coordinated effort 
with the Oxford Suicide Prevention Coalition to develop a suicide prevention plan for Oxford 
County. 


Appendix #4 

National Strategy Guidelines in Other Countries 

2003/04 

Finland 

Finland was the first nation to develop a comprehensive national suicide prevention strategy. The 
National Board of Health formulated a 10-year strategy in 1986 to reduce their high suicide rates by 
20 percent. Their rates increased during the first years of the project to a peak in 1990, followed by 
a reduction of 20% between 1991 and 1996, and an overall reduction of 9% from the 1986 base 
rate. It is the only national strategy to have a completed international peer evaluation. 

Norway 

Norway established the National Plan for Suicide Prevention (1994-1999) under the direction of 
their National Board of Health. Annual funding of 6 million NOK (approx. $1.2 Million CAD) was 
approved. The objectives of the plan were externally evaluated and largely achieved. The plan was 
extended as Measures Against Suicide (2000-2002) that includes a national training strategy under 
the direction of National Board of Health. 

Sweden 

In 1997 The Swedish National and Stockholm County Centre for Suicide Research and Prevention 
was designated a WHO Collaborating Centre in order to assist the WHO in initiating and 
evaluating suicide preventive research and programmes. The centre has a national responsibility for 
devising measures to prevent suicide and is active in four main areas -research and development of 
suicide preventive methods, epidemiological surveillance, information and teaching. 

England 

In 1994, the Department of Health established a target of reducing national suicide rates by at least 
15% and the suicide rate for severely mentally ill people by at least 33% by the year 2000. In 2002 
England released its national strategy for suicide prevention, which will be administered by the new 
National Institute of Mental Health. 


Australia 

Australia initiated a four-year $13 million budget for a Here For Life Youth Suicide Prevention 
Initiative in 1995/96. In 1999 the Federal Budget allocated $39.2 million over four years to the 
National Suicide Prevention Strategy (NSPS) to extend suicide prevention strategies across the age 
spectrum, addressing the needs of all groups at risk of suicide or suicidal behaviour, including 
youth. The National Advisory Council on Suicide Prevention was established to advise 
on implementation of the funds. Of the total budget, 40% was allocated to projects of national 
relevance with the remaining funds for all States and Territories to allocate through an appropriate 
selection process. 

New Zealand (Youth) 

The National Youth Suicide Prevention strategy was published in 1998. It has two parts: In Our 
Hands, which is the general population strategy and Kia Piki Te Ora o te Tatamariki (Strengthening 
Youth Wellbeing), which specifically targets Maori needs and issues. 

United States 

The US Senate and House passed resolutions (I998) that recognized suicide as a major public 
health problem. The process of developing a national strategy was grounded to the UN national 
strategy guidelines and spearheaded by the volunteer led Suicide Prevention Advocacy Network 
(SPAN) with the help of public and private supporters. The issue was championed by the Surgeon 
General with the release of a Call for Action report in 1999. The first-ever national suicide 
prevention strategy was published in 2001 and implementation steps are now underway. 

Scotland 

"Choose life: A National Strategy and Action Plan to Prevent Suicide in Scotland" was published in 
December 2002 by the Scottish Executive. This document outlines the national and local strategy 
for suicide prevention in Scotland and raises issues such as public awareness, taking action to 
prevent problems arising in the first place, providing early support and intervention where problems 
do occur, developing a wider range of supports and services, improving training for front-line 
workers, and research and monitoring. 

Canada 

In 2004, the Canadian Association for Suicide Prevention publishes the CASP Blueprint, Canada’s 
first National Suicide Prevention Strategy. 


Appendix #5 
References used by CASP 

Beland, Y. (2002). Canadian Community Health Survey – methodological overview. Health 
Reports, 13(3), 9-14. 
Bland, R. C., Newman, S. C., & Dyck, R. J. (1994). The epidemiology of parasuicide in Edmonton. 
Canadian Journal of Psychiatry, 39(8), 391-396. 
Clayton, D., & Barceló, A. (1999). The cost of suicide mortality in New Brunswick, 1996. 
Chronic Diseases in Canada, 20(2), 89-95. 


Commonwealth Department of Health and Family Services, Mental Health Branch. (1997). 


Youth Suicide in Australia:The National Youth Suicide Prevention Strategy. Canberra, Australian 
Capital Territory: Australian Government Publishing Service. 

Department of Health. (2002). National suicide prevention strategy for England. London, UK 

Fiske, D. Heather (1998) Suicide Prevention for Lawyers, Judges, Law Students. 

The Health, Wellness and Recovery Education Series of the Legal Profession Assistance 
Conference. 

Gouvernement du Québec, Ministère de la Santé et des Services sociaux. (1998). S’entraider pour 
la Vie: Stratégie Québécoise D’Action Face au Suicide. Québec City, PQ: Bibliothèque nationale 
du Québec. 

Health and Welfare Canada. (1987). Suicide in Canada: Report of the National Task Force on 
Suicide in Canada. 

Ottawa, ON: Minister of National Health and Welfare. 

Health Canada. (1994). Suicide in Canada: Update of the Report of the Task Force on Suicide in 
Canada. Ottawa, ON: Minister of National Health and Welfare. 


Health Canada. (2001). Unintentional and intentional injury profile for Aboriginal people in 
Canada 1990-1999. Ottawa, ON: Minister of Public Works and Government Services Canada. 

Health Canada. (2002). A report on mental illnesses in Canada. Ottawa, ON: Health Canada 
Editorial Board. 

Health Canada. (2002). Healthy Canadians: A federal report on comparable health indicators 2002. 
Ottawa, ON: Minister of Public Works and Government Services Canada. 

Hill, Adrian (1997) LPAC Study on Lawyer Suicide. (1998) LPAC National Suicide Prévention 
Program. (2003) LPAC Report on Its Suicide Prévention Program. 

Inuit Tapiriit Kanatami. (2002). Suicide prevention in Inuit communities: An Inuit Tapiriit 
Kanatami discussion paper (Draft). Ottawa, ON 

Kerkhof, A. J. F. M., Schmidtke, A., Bille-Brahe, U., De Leo, D., & Lönnqvist, J. (Eds.). (1994). 

Attempted suicide in Europe: Findings from the Multicentre Study on Parasuicide by the WHO 
Regional Office for Europe. Leiden, The Netherlands: Leiden University, DSWO Press. 

Kingdon, D., & Jenkins, R. (1995). “The health of the nation”: Suicide prevention in England. 
Italian Journal of Suicidology, 5(1), 9-17. 

Langlois, S., & Morrison, P. (2002). Suicide deaths and suicide attempts. Health Reports, 13(2), 9


22. 
Leenaars, A. A., Wenckstern, S., Sakinofsky, I., Dyck, R. J., Kral, M. J., & Bland, R. C. (Eds.). 
(1998). 

Suicide in Canada. Toronto, ON: University of Toronto Press. 

Mehlum, L., & Reinholdt, N. P. (2001). The Norwegian Plan for Suicide Prevention: Follow-up 
Project 2000-2002: 

Building on positive experiences. Retrieved April 15, 2004, from 
http://www.med.uio.no/ipsy/ssff/engelsk/menuprevention/Mehlum.htm 

Ministry of Youth Affairs, Ministry of Health, & Ministry of Maori Development. (1997). 
An approach for action: Phase two in the development of a national strategy to help prevent youth 
suicide in New Zealand. Wellington, New Zealand 

National Council for Suicide Prevention, National Board of Health and Welfare, National Institute 
of Public Health, & Centre for Suicide Research and Prevention. (1996). Support in suicidal crises: 


The Swedish National Programme to develop suicide prevention. Stockholm, Sweden: National 
Board of Health and Welfare. 

Norwegian Board of Health. (1995). The national plan for suicide prevention 1994-1998. Oslo, 
Norway (Report IK-2539) 

Nunavut Department of Health and Social Services. (2002). Report on comparable health indicators 
for Nunavut and Canada. Iqaluit, NU: Health and Social Services, Information and Research 
Section. 

Ramsay, R. F., & Tanney, B. L. (Eds.). (1996). Global trends in suicide prevention: Toward the 
development of national strategies for suicide prevention. Mumbai, India: Tata Institute of Social 
Sciences. 

Retterstøl, N. (1995). The national plan for suicide prevention in Norway. Italian Journal of 
Suicidology, 5(1), 19-24. 

Sørås, I. (2000). The Norwegian plan for suicide prevention 1994-1999: Evaluation findings. 
Retrieved April 15, 2004, from http://www.med.uio.no/ipsy/ssff/engelsk/Soeraas.htm 

Statistics Canada. (2001). Leading causes of death at different ages, Canada, 1998. Ottawa, ON: 
Author. (Catalogue No. 84F0503XPB) 

Scottish Executive. (2003). Choose life: A national strategy and action plan to prevent suicide in 
Scotland. Edinburgh, Scotland 

Taylor, S. J., Kingdom, D., & Jenkins, R. (1997). How are nations trying to prevent suicide? An 
analysis of national suicide prevention strategies. Acta Psychiatrica Scandinavica, 95(6), 457-463. 

United Nations, Department for Policy Coordination and Sustainable Development. (1996). 
Prevention of suicide: Guidelines for the formulation and implementation of national strategies. 
New York, NY: Author. Upanne, M., & Arinperä, H. (1993). Finlandi’s suicide prevention project 
(1986-1996). Helsinki, Finland: 

Finnish National Research and Development Centre for Welfare and Health. 

U.S. Department of Health and Human Services, Public Health Service. (2001). National strategy 
for suicide prevention: Goals and objectives for action. Rockville, MD 
World Health Organization. (2002). World report on violence and health. Geneva, Switzerland 


Appendix #6 

Health Canada’s Canadian Institutes of Health Research (“CIHR”), 

Report on the Workshop on Suicide-Related Research in Canada, Montreal, February 7-8, 2003, 
identified 6 Broad Themes for Ongoing Investigation, as follows: 

In alphabetical, not priority order 

1. Data Systems: Improvement and Expansion 
The improvement and expansion of data systems depends on a strong classification system, 
reliability and the elimination of biases. Data should be comprehensive, e.g., include information 
on both completed suicides and suicidal behaviours. 

2. Evidence-based Practices 
Research on evidence-based practices includes the evaluation of interventions (ranging from 
clinical treatments, public education and professional/volunteer training to systems-level 
interventions, policy changes, and strategies for improving knowledge translation and uptake). The 
focus of evaluative studies can be broad, including the impact on practice and community 
responses. Research under this theme may also address the determination of what constitutes 
acceptable influence, and as such will likely use (and examine the use of) methodologies that 
extend well beyond Random Clinical Trials to include various qualitative and quantitative 
approaches as well as indigenous knowledge. Also eligible would be studies of how suicide 
research and the development of evidence-based practices are influenced by current peer review 
and ethics review processes, and research into the nature of evaluation in this subject area, 
including its intent and utilization. 

3. Mental Health Promotion 
The Mental Health Promotion theme includes components such as actualization, advancement, the 
development and dissemination of culturally and community-appropriate information. It also 
covers community capacity, community-based initiatives and cultural continuity at multiple levels, 
e.g., individual/family/community/ nations. Research topics include protective factors, risk factors 
and resiliency over the life span and address issues related to discrimination, care for the caregiver 
(the wounded healer), social competence, shame, stigma and the perception of mental illness. The 
focus is on a problem-solving approach that is based on efficacy and excellence and that 


acknowledges the need for growth and fulfillment of human potential. Positive psychology and the 
effects of social supports and isolation should also be considered under this theme. 

4. Multidimensional Models for Understanding Suicide-Related Behaviours 
Multidimensional models can be community-and theory-driven, but must be based on theoretical 
models and multi-dimensional approaches. Models must (a) address more than one factor and (b) 
explore interactions among factors. There is a need to encourage (but not require) interdisciplinary 
themes. The focus must be broader than suicide, i.e., it should cover the spectrum of suicide-related 
behaviour. Priority should be given to projects where design, methodology and measurement cross 
different domains. 

5. Spectrum of Suicide Behaviours, including Suicide Attempters 
The spectrum of suicidal behaviours includes aborted, attempted and assisted suicide, attempts 
disguised as accidents, deliberate self-harm, euthanasia, the hastening of death through life-
threatening or self-injurious behaviour, suicidal gestures, suicidal ideation and suicide threat. It 
includes non-fatal/sub-intentional attempts, premature death, risk behaviour, screening 
identification. There is a need for mutually-accepted operational definitions for terms such as 
parasuicide. 

6. Suicide in Social and Cultural Contexts 
The incidence of suicide in Canada varies dramatically as a function of institutional, regional, 
social, spiritual, cultural and political contexts. It is critical to develop new knowledge about how 
these contextual factors have an impact, not only on the incidence of suicide, but on determining 
what constitutes best practices in the prevention of suicide and in responding to suicide-related 
social and human problems. 

The CIHR Report on the Workshop on Suicide-Related Research in Canada can be found 
in its entirety at: http://www.cihr-irsc.gc.ca/e/institutes/inmha/18918.shtml 


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Appendix #7 
Oxford Suicide Prevention Coalition 
Purpose: 
To work toward the development of a coordinated Oxford County Suicide Prevention Strategy with 
the ultimate goal of suicide reduction in Oxford County. 
Functions: 
. Collect and document current community resources 
. Development and dissemination of resources 
. Organization and facilitation of public community forums for stakeholder feedback 
. The development of proposals, as required, to provide resources for activities of the 
coalition 
. Conduct public consultation on issues related to suicide 
Vision 
We envision a community that is, by its attitudes and practice, compassionate, caring, informed, 
and educated and supports the well being and safety of all people. 
Mission 
Believing that every person has the right to be supported in living a healthy, positive life, our 
mission is to reduce suicidal behaviour and its impact on individuals, families, and communities 
within Oxford County. 
Goals 
1. To reduce suicidal behaviour in Oxford County through: 
. Public awareness 
. Education and skill development 
. Public health advocacy 
2. To reduce the impact of suicidal behaviour on individuals, families, groups and 
communities within Oxford County through: 
. Advocacy for improved or enhanced services 
. Community consultation, coordination and collaboration 
Membership: 
Efforts will be made to ensure that membership reflects a wide range of stakeholders. This includes 
geographical representation as well as skill, organizational and personal experiences. 
. Various ministries/government representation(local municipal representation) 
. Faith Communities 
. Mental Health Workers 
. Injury Prevention Workers 
. Health Promotion Workers 
. Family Violence Workers 
. Child and Youth Workers 
. Labour Union Reps 

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. Survivors of Suicide (family members impacted) (those who have attempted) 
. Seniors representation 
. Community Professionals 
. Education System Representation 
. Hospital Representation 
. Physicians and psychiatrist 
. Emergency Providers – EMS and Police 
. Industry 
. Media 
. Any Concerned Individual or Organization 
. YOU! 
Membership in the Coalition will be implied through individual participation and/or monetary 
donations. 
Current Oxford Suicide Prevention Coalition Executive 
Co-Chair Dr. Bill McLeish wmcl@execulink.com 
Co-Chair Terri McCartney terrimccartney@cmhaoxford.on.ca 
Treasurer Tony Sheldon inthemist@sympatico.ca 
Member at Large Vicki Travnicek mar8vic@porchlight.ca 
Letters and enquiries to the Oxford Suicide Prevention Coalition may be directed in care of the 
Canadian Mental Health Association-Oxford County Branch 
522 Peel Street 
Woodstock ON N4S 1K3 
519 539-8055 or 1 800-859-7248 

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