Suicide and suicide prevention in the Canadian Armed Forces

Contacts

Media Relations
Department of National Defence
Phone: 613-996-2353
Toll-Free: 1-866-377-0811
Email: mlo-blm@forces.gc.ca

Suicide is a public health issue for all Canadians, including Canadian Armed Forces (CAF) members. Suicide is the second leading cause of death for those aged 15 to 34 in the Canadian general population.

The CAF has an extensive mental illness awareness and suicide prevention program consisting of clinical and non-clinical interventions by generalist and specialist clinicians, mental health education, and suicide awareness information. Great efforts are made to identify people at risk for mental health problems and to provide them with the assistance that they require. However, it is important to note that not all people who complete or attempt suicide can be identified in advance.

Even with a strong health care system, it is essential that all military personnel, like all Canadians, recognize mental health issues as they develop and progress. We each have a role to play in identifying and assisting those affected by mental illness. Once we are collectively educated and able to recognize the onset of mental illness, we can help our friends, colleagues, and family members by encouraging them to seek care. 

The CAF remains committed to reducing the barriers that may interfere with obtaining timely mental care. Stigma is one of these barriers. Through dialogue, training, and leadership, we can create a culture in which care-seeking is both encouraged and facilitated. The CAF has made great strides with respect to these barriers, but the work is not complete – both in the CAF and in society at large.

Number of suicides

The CAF monitors the rates and trends of suicide and other mental health issues in its population in order to gain more understanding of underlying issues and to mitigate risks.

Within 72 hours of a death, investigating police will typically receive an initial indication from the independent civilian coroner of whether the death was the result of foul play, an accident, or suicide. This, along with information such as police reports and medical records, is used by the CAF in making an informed decision with respect to the conduct of a Medical Professional Technical Suicide Review and a Board of Inquiry into a suspected suicide.

Please see Table A: Suicides in the CAF, by year and Force, 2004-2017 at the bottom of the page

While these statistics are provided to give a complete picture of the total number of suicides in the CAF over the past 12 years, only a sub-section of these (male Regular Force) are used to determine suicide rates and to compare to a similar age-gender group in the general Canadian population. This is because Regular Force female suicide numbers tend to be too small to be statistically analyzed with any degree of accuracy while the Reserve Force suicide numbers are more difficult to track and confirm as it is uncertain whether or not all suicides of reservists are reported to the CAF.

Attempted suicides

Suicide attempts are taken seriously by the CAF. The chain of command, including the Chief of the Defence Staff, is alerted to possible attempted suicides through a variety of mechanisms, including unit significant incident reports and reports from military police or third-party authorities. Each attempted suicide reported to the chain of command is recorded and monitored to ensure we are doing all we can to support the member and to ensure that the health care team and the chain of command are working together to provide the best possible outcome for the ongoing safety and care of the member.  

The reporting route of an attempted suicide depends on the first responder. For privacy and patient confidentiality reasons, the doctors within Canadian Forces Health Services (CFHS) do not report attempted suicides unless the patient provides consent to release that information. The intent of the reporting is to formally review care provided to members to ensure the member is receiving the best possible care and to help better understand suicidal behaviour. The number of reported attempts cannot be used as statistical rates of attempted suicide.  There is no common medical definition of 'suicide attempt' and reported attempts may vary from simple calls for help, to actual self-injury and other motivations. Thus, the number of reported suicide attempts does not represent the actual situation nor the complexity of the issue.  

Suicide rates

The figures in Table B originate with the Directorate of Force Health Protection, and are based on the information collected by the Administrative Investigation Support Centre. These figures include male Regular Force personnel only.

The values in Table B are calculated at a rate per 100 000, like those provided by Statistics Canada for the general Canadian population. Consistent with accepted research methodology, the CAF compares and monitors the number of suicides over a five-year period in order to determine if fluctuations are random or statistically significant.

The suicide rate in Regular Force Males in 2010-14 increased compared to previous five-year periods. While suicide affects all components of the CAF, this increase is due to the increased suicide rate amongst those serving within the Canadian Army (CA), the rate being two to three times higher than those serving with other Commands. One of the risk factors behind this finding is the increased rate of Operational Stress Injuries, like PTSD, in groups who deployed to high threat locations. This is more likely to apply to personnel within the Army. 

Read the latest version of the Suicide Report.

Investigation process

Each suicide in the CAF is investigated. The Canadian Forces National Investigation Service (CFNIS) investigates all sudden deaths which occur within their jurisdiction. The CFNIS gathers evidence and works with the coroner who then determines the cause of death. CFNIS investigations are conducted in accordance with Canadian police standards. Sudden deaths outside of CFNIS jurisdiction are investigated by local police authorities.

When Canadian Forces Health Services (CFHS) is made aware of a suspected suicide, an initial medical record review is conducted. The responsible civilian coroner’s office is responsible for determining the official cause of death.

For each completed suicide (often before confirmation from a coroner is received by the CAF) a medical review is conducted within a few days after the death. This is usually followed by the initiation of a Medical Professional Technical Suicide Review. This is an in-depth medical review conducted by a two-person team typically composed of a General Duty Medical Officer and a psychiatrist. These clinicians interview family, friends, colleagues, the chain of command, and health care providers in order to gain an understanding of the circumstances surrounding the death. Lessons learned can be used to improve the CAF suicide prevention program or other health services programs. To date, such reviews have provided greater insight into suicide in the CAF and how to enhance the already high-quality mental health care provided by the CAF.

A Board of Inquiry is also normally convened in cases where the cause of death is suspected to be from self-inflicted means. The motivating factors that led to the event are often among the issues examined during this process.

Emergency care

In the case of an emergency, CAF members in crisis can see a primary care physician on a 'walk-in' basis, without an appointment, at one of the CAF medical clinics during normal business hours. All primary care physicians have been trained in suicide assessment, management, and prevention. Members may also go to a civilian health care centre during quiet hours or they may call 911 (for an acute emergency) or 1-800-268-7708 to reach the Member Assistance Program, 24 hours a day, from anywhere in the world, and receive a confidential referral for help.

The friends and family of someone in need of help can also contact emergency services, who will either bring the suicidal member to the base clinic during working hours, or to the local hospital emergency department after hours. Military and civilian police, as well as emergency services personnel, are trained in mental health crises and in helping and managing the suicidal person.

Resources and support

In addition to the primary care services and mental health clinics available on all wings and bases, CAF members with mental health concerns and their families currently have access to a range of CAF and Veterans Affairs Canada services and programs including:

  • counselling under the Member Assistance Program at 1-800-268-7708;
  • the 24/7 Family Information Line at 1-800-866-4546;
  • peer support through the Operational Stress Injury Social Support network;
  • support from their base chaplains;
  • the guidance of the more than 40 Military Family Resource Centres located at CAF installations across the country, in the U.S., and in Europe.

For more information on support programs available to CAF members and their families, please visit the Mental Health Services and Support Backgrounder and the You’re Not Alone webpage.

Education programs

CFHS has several programs aimed at preventing or mitigating the effects of stress. Educational programs are delivered to various levels of leadership and cover all aspects of a member’s career. Through the Road to Mental Readiness program, the Directorate of Mental Health Training and Education Section has developed an evidence-based mental health curriculum that has been integrated in CAF career courses. Since 2009, over 56 000 CAF members have received some form of mental health training and education. For more information on these courses and other mental health education and awareness programs, please refer to the Post-Traumatic Stress Disorder Backgrounder.

The CAF health promotion program, Strengthening the Forces, offers mental fitness and suicide awareness and education training based on the A.C.E. (Ask, Care, Escort) model. At the leadership level, a one-day course called Mental Fitness and Suicide Awareness helps prepare supervisors to promote mental fitness and to mitigate the incidence of mental health injuries, including deliberate self-harm and suicide, within the military community. In addition to the supervisor’s course, a Mental Fitness and Suicide Awareness full-day course is available to all CAF members and their families, as are half-day mental fitness awareness sessions and briefings. This training takes place under the CAF’s larger health promotion umbrella, which includes Addictions Awareness & Prevention, Active Living & Injury Prevention, Nutrition Wellness, and Social Wellness programs. For more information, please visit the Strengthening the Forces website.

Research and reporting

Over the past 10 years, the CAF has put significant effort into conducting research and enhancing the care provided to members. The goal is to continue to enhance our research capability and conduct world leading research. The research, performed entirely within CFHS or with partners from academia or amongst our allies, will help us to better understand, identify, and treat mental health conditions.

As part of the CAF leadership’s commitment to improve and enhance the care and support services currently available to members, the CAF will continue to monitor suicide rates and other trends that may lend insight into the overall mental health and general well-being of its population.

Canadian Forces Expert Panel on Suicide Prevention

The Canadian Forces Expert Panel on Suicide Prevention, held in Halifax in September 2009, found that the CAF has a strong suicide prevention program in place that compares most favourably to those of its North Atlantic Treaty Organization (NATO) partners and closest allies.

The panel also found that the CAF has implemented, or is in the process of implementing, nearly all of the suicide prevention strategies most consistently identified in civilian scientific literature. These strategies include, but are not limited to, education/awareness programs, screening, pharmacotherapy and psychotherapy, resilience training, and systematic efforts to overcome barriers to mental health care. In addition, the panel expressed agreement that the CAF’s approach also targets additional factors that are more specific to military organizations.

Since the panel, the CAF has established the Medical Professional Technical Suicide Review process and implemented a patient follow-up protocol for missed mental health appointments to help prevent suicide, which are consistent with mental health best practices.

The CAF has also become involved in initiatives that promote responsible media reporting of suicides. CAF mental health experts have shared guidelines on responsible reporting and have been made available to discuss the complexities of suicide.

Read the Panel’s full report on Suicide Prevention.

Annual Suicide Report

The CAF regularly conducts analyses to examine suicide rates and the relationship between suicide and deployment. This report uses suicide rates for male Regular Force members to compare to the Canadian population using standardized mortality ratios.

Read the latest version of the Suicide Report.

Canadian Forces Cancer and Mortality Study

The Canadian Forces Cancer and Mortality Study is a collaborative effort among the CAF, Veterans Affairs Canada, and Statistics Canada. All CAF members who joined the Regular Force from January 1, 1972, to December 31, 2006, were included in this study. The initial mortality results released in spring 2011 looked at both serving and former CAF members. The results showed that the risk of suicide within this group was comparable to the Canadian population. However, when considering the population of former CAF personnel alone, men in this group had a higher risk of suicide compared to the Canadian population. Further analysis identified the following associated risk factors: service before 1986, shorter period of service (less than 10 years), former Non‑Commissioned Member rank, and release for involuntary or medical reasons.

For more information and initial mortality results, please visit Canadian Forces Cancer and Mortality Study.

Suicide contagion and media reporting guidelines

Evidence has demonstrated that there is an increased prevalence of suicidal behaviour in populations where those at risk have experienced the suicide death of a friend, colleague, family member, or someone they can closely identify with. In the CAF, this is of particular concern because of the shared experiences of individuals in the population (i.e. CAF personnel live in close quarters and have similar occupational experiences). If a suicide occurs in the CAF population, there is the risk that others will relate to the deceased individual and this could in turn lead to an increase in suicidal behaviour.

We encourage dialogue about mental health and suicide, but we also acknowledge the unintended negative impact these discussions can have on the health of personnel at risk of suicidal behaviour. This risk needs to be considered when details surrounding a suicide-related event are communicated both internally and externally. 

In particular, there is concern among health professionals that irresponsible media reporting of suicide will lead to contagion. In other words, the concern is that more suicides will occur as a result of media coverage. The World Health Organization reports that the review of over 50 investigations has shown that “media reporting of suicide can lead to imitative suicidal behaviours.”

For more information on responsible media reporting on suicide, please visit:

The way forward

Suicide is a tragedy and an important public health concern. Significant investment and commitment has been made to ensure the CAF has the health, education, and awareness programs required to help identify people at risk for mental health problems and to provide them with assistance.

Caring for CAF members and their families will remain a priority. The CAF has provided leadership in the area of mental health and remains committed to working with its partners to ensure that our personnel, with their families, who are called to sacrifice so much in service to their country, receive quality care and support. The CAF continues to assess its capabilities and adjust its resources to ensure it is meeting the increasing complexities and demands associated with caring for our own.

But we can’t do it alone. We each have a role to serve in identifying and assisting those affected by mental health concerns. Often, peers and family members are the first to notice behavioural changes, and when we do, we must not be afraid to act – do not underestimate the impact you can have.

Table A: Suicides in the CAF, by year and Force, 2004-2017

 

Table A: Suicides in the CAF, by year and Force, 2004-2017
 Calendar Year Regular Force Reserve Force
2017 (as of Nov 28) 12 3
2016 (as of May 18, 2017) 15 3
2015 15 3
2014 17 4
2013 10 3
2012 13 4
2011 22 3
2010 12 1
2009 14 8
2008 14 1
2007 10 2
2006  8 3
2005 10 1
2004 10 3

It is important to note that the suicide statistics for any given year may be subject to change depending on the results of the investigation into the sudden death. The following table contains the most accurate statistics based on the information available at the time of publication.

Table B: Suicide rates among male Regular Force personnel, 1995-2015

 

Table B: Suicide rates among male Regular Force personnel, 1995-2015
Year Number of CAF Regular Force Male Person-YearsNumber of CAF Regular Force Male SuicidesMale Reg Force Suicide Rate per 100,000 Population
 2015  56 284 14 24.9
 2010-14 289 866 68 23.5
 2014  56 699 16  
 2013  57 687  9  
 2012  58 135 10  
 2011  58 622 21  
 2010  58 723 12  
 2005-09 275 606 51 19
 2009

 56 813

12  
 2008  55 704 13  
 2007  55 140  9  
 2006  54 301  7  
 2005  53 648 10  
 2000-04 263 323 50 19
2004  53 873 10  
2003  54 137  9  
2002  52 747  9  
2001  51 029 10  
2000  51 537 12  
1995-99 281 533 56 20
1999  52 689 10  
1998  54 284  13  
1997  54 982 13  
1996  57 323  8  
1995  62 255 12   

Le temps-personne se définit comme étant une unité de mesure combinant personne et temps, qui est utilisée comme dénominateur dans le calcul des taux d’incidence et de mortalité lorsque, pendant des périodes plus ou moins longues, les sujets présentent un risque de développer une maladie ou de mourir. Il s’agit de la somme des différentes périodes de temps à risque pour chacun des sujets. L’unité de mesure la plus largement utilisée est année-personne. (Traduction) (A Dictionary of Epidemiology. M Porta, Greenland S, Last JM, eds. Fifth Edition. New York (USA): Oxford UP, 2008.)

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